Comparison Of Alkaline Hydrolysis And Newster Sterilizing Alternative Treatment Technologies And Cultural Beliefs On Placenta Management In Gauteng, South Africa

Thesis

The history and development of a health care risk management legal framework in South Africa has come a long way since the 1500s. A historical overview has shown that continuous development of legal requirements took precedence and that legislative promulgations were typically followed by systems development. The aim of the study was twofold. First, the study aimed to compare the feasibility of two types of alternative technologies for the treatment of placentas, namely the Alkaline Hydrolysis treatment technology and the NEWster® steriliser system. Various concerns have been raised regarding the operational handling, management, maintenance, and optimal treatment efficiency of these two systems. It was found that the volumes of generated waste in terms of generation versus treatment play a role in the choice of the plant that should be installed. Moreover, based on a comparative evaluation of the two systems, it is evident that the NEWster®, which is the smaller of the two units, is more suitable for small scale operators such as district hospitals, clinics, and community health establishments. This is because the cycle time of the NEWster® is shorter, the space needed to install a unit is less, and the capacity of this unit in terms of generation rates is more in line with international requirements than that of the Alkaline Hydrolysis system. The second study was to determine the prevalence of traditional beliefs in the management and disposal of placentas. Health professionals were recruited from health establishments in the Department of Health in Gauteng, South Africa. A quantitative investigation was conducted. A questionnaire was used to obtain the required data from health professionals in governmental hospitals in Gauteng. These professionals were selected from five categories, namely matron/nursing supervisor/operational manager, professional nurse, nursing assistant, medical practitioner (doctor), and health care risk waste officer/environmental health practitioner. The envisaged study site would have consisted of the obstetrics and maternity wards of 27 hospitals, but 15 hospitals were ultimately included in the study. The highest district participation rate was from hospitals in the Tshwane district (50.7%), while the lowest participant rate was medical practitioners at 11.11%. It was determined that the placentas of all the birth mothers (100%) were individually packed in small red plastic bags after giving birth. However, a splash risk was identified. Differences in timeframes were detected for the placement of placentas after birth into Specicans due to theatre procedures, and this could take up to 30 minutes. The placentas were stored in freezers that were not equipped with a thermometer or mechanism to verify freezer temperatures. There was a 50% chance that a mother who was not aware of the procedures regarding her placenta would request it after it had already been disposed of in a Specican. Moreover, it was evident that health professionals were unsure which procedures to follow should various religious practices associated with a patient’s right to take the placenta home needed to be addressed. Family members generally collected patients using their own vehicles and it was reported that the placenta would be buried at home as quickly as possible. It is noteworthy that a small percentage of the respondents indicated that placentas would be given to traditional healers. Taking religion (which is central to the cultural diversity discussion) into account, the most dominant group that tended to take the placentas home was the Indian group. The Zulu population group was the secondary most likely group to take the placenta home. The traditional rituals followed at home were not well defined or described by the participants, which suggests that many Health Professionals may not be aware of customs to dispose of placentas in the traditional manner. It was also found that there was no standardised record form for placenta handling, and thus a trustworthy data base for placenta management procedures was a challenge. Most of the health professionals (84.13%) had been trained. The study revealed that medical practitioners (i.e., doctors) felt that health care risk waste management was not their responsibility.