Negotiating quality standards for effective delivery of labor and childbirth care in Nigeria and Uganda.

OBJECTIVE: "Negotiated standards" describe a level of quality of care that is acceptable and achievable within a specific health system, based on consensus between key stakeholders. This paper presents the development of negotiated standards for effective labor and childbirth care in selected hospitals and communities in Nigeria and Uganda. METHODS: A four-step development process involving different methodologies. The process included: (1) review and synthesis of internationally recognized intrapartum clinical principles and practices; (2) primary qualitative research to assess values and preferences of women and healthcare providers, and practices that align with these preferences; (3) draft contextualization of effective and ineffective behaviors to reflect values and preferences; and (4) WHO-mediated negotiations between relevant stakeholders, including community members, providers, and administrators. RESULTS: The primary outcomes of this process were a comprehensive set of effective behaviors and clinical practices covering the main domains of quality of care, which are practical and easy to communicate, implement, and audit across all levels of healthcare delivery. CONCLUSION: The process demonstrates that health facilities and providers can be motivated to adopt standards of care that uphold the values and preferences of both service users and providers, while adhering to international best practices.

Polyembolokoilamania: Self-insertion of transistor radio antenna in male urethra.

Though self-insertion of a foreign body in the male urethra is an infrequent urologic emergency, a weird variety of self-inserted foreign bodies have been reported. Most of these are attributed to autoerotic stimulation, a consequence of mental illness or the result of drug intoxication. We report an unusual case of a 65-year-old African man who self-inserted a broken transistor radio antenna into his urethra to serve as an improvised 'itchstick' to ease a bothersome itchy urethral condition. The foreign body subsequently migrated proximally out of reach. He presented a week after with urethral bleeding following nocturnal penile erections and we describe his evaluation and the challenge of retrieval. The reasons for self-inserting objects into the urethra may be as varied as the foreign bodies themselves and may include objects being used as an improvised 'itchstick' for itchy urethral conditions. The urologist's creative tendencies will often be required in safely removing these objects.

Disseminated Langerhan's cell histiocytosis: a case report and review of the literature.

Langerhan's cell histiocytosis is characterized by the presence of large mononucleated cells associated with inflammatory cells. We describe the clinical presentation, histopathology and some immunohistochemistry findings, in an eight-year-old female patient.