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1.
BMC Womens Health ; 21(1): 142, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827536

RESUMO

BACKGROUND: Accessing surgical repair poses challenges to women living with female genital fistula who experience intersectional vulnerabilities including poverty, gender, stigma and geography. Barriers to fistula care have been described qualitatively in several low- and middle-income countries, but limited effort has been made to quantify these factors. This study aimed to develop and validate composite measures to assess barriers to accessing fistula repair in Nigeria and Uganda. METHODS: This quantitative study built on qualitative findings to content validate composite measures and investigates post-repair client surveys conducted at tertiary hospitals in Northern and Southern Nigeria and Central Uganda asking women about the degree to which a range of barriers affected their access. An iterative scale development approach included exploratory and confirmatory factor analyses of two samples (n = 315 and n = 142, respectively) using STATA 13 software. Reliability, goodness-of-fit, and convergent and predictive validity were assessed. RESULTS: A preliminary 43-item list demonstrated face and content validity, triangulated with qualitative data collected prior to and concurrently with survey data. The iterative item reduction approach resulted in the validation of a set of composite measures, including two indices and three sub-scales. These include a Financial/Transport Inaccessibility Index (6 items) and a multidimensional Barriers to Fistula Care Index of 17 items comprised of three latent sub-scales: Limited awareness (4 items), Social abandonment (6 items), and Internalized stigma (7 items). Factor analyses resulted in favorable psychometric properties and good reliability across measures (ordinal thetas: 0.70-0.91). Higher levels of barriers to fistula care are associated with a woman living with fistula for longer periods of time, with age and geographic settings as potential confounders. CONCLUSIONS: This set of composite measures that quantitatively captures barriers to fistula care can be used separately or together in research and programming in low- and middle-income countries.

2.
BMJ Glob Health ; 5(7)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32636314

RESUMO

INTRODUCTION: Prolonged obstructed labour often results from lack of access to timely obstetrical care and affects millions of women. Current burden of disease estimates do not include all the physical and psychosocial sequelae from prolonged obstructed labour. This study aimed to estimate the prevalence of the full spectrum of maternal and newborn comorbidities, and create a more comprehensive burden of disease model. METHODS: This is a cross-sectional survey of clinicians and epidemiological modelling of the burden of disease. A survey to estimate prevalence of prolonged obstructed labour comorbidities was developed for prevalence estimates of 27 comorbidities across seven categories associated with prolonged obstructed labour. The survey was electronically distributed to clinicians caring for women who have suffered from prolonged obstructed labour in Asia and Africa. Prevalence estimates of the sequelae were used to calculate years lost to disability for reproductive age women (15 to 49 years) in 54 low- and middle-income countries that report any prevalence of obstetric fistula. RESULTS: Prevalence estimates were obtained from 132 participants. The median prevalence of reported sequelae within each category were: fistula (6.67% to 23.98%), pelvic floor (6.53% to 8.60%), genitourinary (5.74% to 9.57%), musculoskeletal (6.04% to 11.28%), infectious/inflammatory (5.33% to 9.62%), psychological (7.25% to 24.10%), neonatal (13.63% to 66.41%) and social (38.54% to 59.88%). The expanded methodology calculated a burden of morbidity associated with prolonged obstructed labour among women of reproductive age (15 to 49 years old) in 2017 that is 38% more than the previous estimates. CONCLUSIONS: This analysis provides estimates on the prevalence of physical and psychosocial consequences of prolonged obstructed labour. Our study suggests that the burden of disease resulting from prolonged obstructed labour is currently underestimated. Notably, women who suffer from prolonged obstructed labour have a high prevalence of psychosocial sequelae but these are often not included in burden of disease estimates. In addition to preventative and public health measures, high quality surgical and anaesthesia care are urgently needed to prevent prolonged obstructed labour and its sequelae.

3.
J Clin Pediatr Dent ; 44(3): 174-179, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32644890

RESUMO

Objective: The aim of the present study was to evaluate the reduction in bacterial loading using Papacarie and Carisolv as an irrigating solution in pulpectomized primary molars. Study design: A controlled, randomized clinical trial involving 120 necrotic canals from both genders between 3 and 7 years old children were included, 30 irrigated with Papacarie [ group I], Carisolv [ group II], 1% NaOCl gel [ group III] and 1% Na0Cl solution [group IV ] each; in all cases, 2 microbiological samples from within the canals were taken with sterile paper points, the first after the canal opening and before the first irrigation, and the second after instrumentation and final irrigation, before obturation. All samples were evaluated by Agar plate method. Results: The results were statistically analyzed by ANOVA. After analyzing samples before and after irrigation in all the groups, a strong significant decrease in bacterial load [ p = < 0.001 ] was found with Papacarie and Carisolv. Conclusion: Papacarie and Carisolv can be suggested as an alternative irrigant for pulpectomy of necrotic teeth.


Assuntos
Dente Molar , Irrigantes do Canal Radicular , Criança , Pré-Escolar , Cavidade Pulpar , Feminino , Ácido Glutâmico , Humanos , Leucina , Lisina , Masculino , Papaína , Preparo de Canal Radicular , Hipoclorito de Sódio
4.
Mhealth ; 6: 12, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32270004

RESUMO

Background: The use of digital health technologies has expanded across low-resource settings, including in programs seeking to improve maternal health care seeking and service usage. However, there has been limited use of these technologies for screening and referral within maternal health, and many interventions have relied on SMS tools, which may have limited impact in settings with low female literacy. Digital health technologies have the potential to increase access to care for chronic maternal morbidities, such as obstetric fistula, and for women facing stigma, geographic isolation, and other sociocultural barriers to care seeking. This study documented the process of developing and implementing an innovative fistula screening and referral hotline using interactive voice response (IVR) technology, and described the service usage results and stakeholder perspectives associated with the hotline. Methods: The IVR hotline was introduced within the context of a broader Fistula Treatment Barriers Reduction Intervention implemented by the USAID-funded Fistula Care Plus project in Ebonyi and Katsina states in Nigeria and Kalungu district in Uganda. The intervention used three communication pathways to disseminate fistula information and conduct fistula screening: trained community agents, trained primary health care providers, and the IVR hotline paired with mass media messaging. All positively-screened women were eligible to receive vouchers for free transportation to an accredited fistula treatment center. Quantitative and qualitative data on intervention implementation and use across all three communication pathways were gathered during intervention implementation, at baseline, midline, and endline; as well as through ongoing program monitoring. This study presents findings specifically on service usage and stakeholder perspectives related to the IVR hotline. Results: Over a period of ten to twelve months of implementation, depending on the intervention area, a total of 566 women completed the IVR hotline screening process. Across the areas, 415 (73%) hotline callers screened positive for fistula symptoms. Hotline users and implementation partners reported positive impressions of the hotline, particularly the ability to preserve anonymity in seeking information and referral for fistula symptoms. Challenges to hotline use included limited mobile phone ownership and poor cellular network connectivity, affecting operability by women and community agents. Conclusions: Implementation of the fistula screening hotline suggests that IVR-based interventions may be useful in expanding access to health services for stigmatized conditions, particularly in settings where literacy is limited. In the current context, such IVR tools require pairing with community and health system partners to complete referral and support clients. Further program experience and evaluation research is required to understand the options for integrating the IVR hotline or other interventions similarly using mobile technologies for screening and referral into broader digital health platforms that are sustained by national health systems or commercial business models.

5.
Trop Med Int Health ; 25(6): 687-694, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32223055

RESUMO

OBJECTIVE: To describe the frequency, causes and post-repair outcomes of NOF in hospitals supported by the Fistula Care Plus (FC+) project in the Democratic Republic of Congo. METHODS: Retrospective cohort study from 1 January 2015 to 31 December 2017 in three FC + supported fistula repair sites. RESULTS: Of 1984 women treated for female genital fistula between 2015 and 2017 in the three FC + supported hospitals, 384 (19%) were considered to be non-obstetric fistula (NOF) cases. 49.3% were married/in a relationship at the time of treatment vs. 69% before the fistula, P < 0.001. Type III (n = 247; 64.3%) and type I (n = 121; 31.5%) fistulas according to Kees/Waaldijk classification were the most common. The main causes of NOF were medical procedure (n = 305; 79.4%); of these, caesarean section (n = 234; 76.7%) and hysterectomy (n = 54; 17.7%) were the most common. At hospital discharge, the fistula was closed and dry in 353 women (95.7%). CONCLUSION: Non-obstetric fistula, particularly due to iatrogenic causes, was relatively common in the DRC, calling for more prevention that includes improved quality of care in maternal health services.


Assuntos
Fístula Vesicovaginal/epidemiologia , Adolescente , Adulto , Cesárea/efeitos adversos , República Democrática do Congo/epidemiologia , Feminino , Humanos , Histerectomia/efeitos adversos , Pessoa de Meia-Idade , Paridade , Características de Residência , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia , Adulto Jovem
6.
Health Care Women Int ; 41(5): 584-599, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31335303

RESUMO

A research-to-action collaboration sought to understand and respond to barriers to female genital fistula treatment in Nigeria and Uganda. This was guided by appreciative inquiry, a participatory approach for transformative programing with four phases: (1) inquire, (2) imagine, (3) innovate, and (4) implement. Through this process, partners designed and refined a treatment barrier reduction intervention using multiple communication channels to disseminate a consistent fistula screening algorithm and provide transportation vouchers to those screening positive. Partnership between an implementation organization, a research institution, and local community partners enabled data-driven design and patient-centered implementation to address specific barriers experienced by women.

7.
J Indian Soc Periodontol ; 23(6): 534-538, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849398

RESUMO

Background: Bleeding gums are one of the common complaints to visit a dentist. Mechanical removal of plaque alone is not sufficient for the reduction of gingival inflammation associated with plaque. Mouthwashes are supplemented to it as a homecare product. The objective of this study is to evaluate the efficacy of 0.2% sodium hypochlorite mouthwash on plaque and gingival inflammation and to assess the clinical parameters of gingivitis patients from baseline to 21 days with the use of 0.2% sodium hypochlorite and 0.2% chlorhexidine mouthwashes. Materials and Methods: This clinical trial study included 60 patients with gingival inflammation evaluated using clinical parameters such as bleeding on probing index, plaque index, and gingival index at baseline and 21 days. Group A patients were given Hi Wash mouthwash and Group B 0.2% chlorhexidine mouthwash with 30 patients in each group. Results: The scores for clinical parameters were significantly reduced after 21 days in Group A and Group B patients, and there was a reduction in plaque-associated gingival inflammation without scaling and root planning. Conclusions: 0.2% sodium hypochlorite mouthwash is as effective as 0.2% chlorhexidine for the treatment of gingivitis as it is an adjunct to mechanical plaque removal in terms of safety, less side effects, less staining and can be used as a routine mouthwash.

8.
J Indian Soc Periodontol ; 23(6): 569-573, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849404

RESUMO

Aim: Among various dental ailments, periodontitis has always had a towering popularity. The inauguration of new classification scheme for periodontal diseases and conditions in 2017 World Workshop has a remarkable impact on the diagnosis of periodontal diseases worldwide. This study is based on comparison between the two classifications by American Academy of Periodontology for diagnosing periodontitis. Materials and Methods: This study focuses on the prevalence estimates of periodontitis by diagnosing the periodontal diseases using two different criteria simultaneously: the first criterion was based on the classification approved in 1999 World Workshop and the other criterion was based on the new classification scheme of periodontal diseases and conditions in 2017 World Workshop. Results: It was found that there was significant reduction in the prevalence estimates (P < 0.001) of periodontitis following the new classification scheme. Conclusion: The new classification scheme recognizes the clinical salience of periodontitis and is more likely to influence the treatment modality of long sufferings of the patients having periodontal problems across the globe. The new classification will also lay the base for future research in the field of dentistry. More future studies are required to assess the prevalence of periodontitis following new classification scheme on a larger scale.

9.
BMC Pregnancy Childbirth ; 19(1): 133, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991979

RESUMO

BACKGROUND: There is a growing recognition that quality of care must improve in facility-based deliveries to achieve further global reductions in maternal and newborn mortality and morbidity. Better measurement of care quality is needed, but the unpredictable length of labor and delivery hinders the feasibility of observation, the gold standard in quality assessment. This study evaluated whether a measure restricted to actions at or immediately following delivery could provide a valid assessment of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC), including essential newborn care. METHODS: The study used a comprehensive QoPIIPC index developed through a modified Delphi process and validated by delivery observation data as a starting point. A subset of items from this index assessed at or immediately following delivery was identified to create a "delivery-only" index. This delivery-only index was evaluated across content and criterion validation domains using delivery observation data from Kenya, Madagascar, and Tanzania, including Zanzibar. RESULTS: The delivery-only index included 13 items and performed well on most validation criteria, including correct classification of poorly and well-performed deliveries. Relative to the comprehensive QoPIIPC index, the delivery-only index had reduced content validity, representing fewer dimensions of QoPIIPC. The delivery-only index was also less strongly associated with overall quality performance in observed deliveries than the comprehensive QoPIIPC index. CONCLUSIONS: Where supervision resources are limited, a measure of the quality of labor and delivery care targeting the time of delivery may mitigate challenges in observation-based assessment. The delivery-only index may enable increased use of observation-based quality assessment within maternal and newborn care programs in low-resource settings.


Assuntos
Parto Obstétrico/normas , Instalações de Saúde/normas , Cuidado Pós-Natal/normas , Avaliação de Processos em Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , África ao Sul do Saara , Técnica Delfos , Feminino , Humanos , Gravidez , Reprodutibilidade dos Testes , Fatores de Tempo , Adulto Jovem
10.
Trop Med Int Health ; 24(1): 53-64, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30372572

RESUMO

OBJECTIVES: To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery. METHODS: We recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. RESULTS: Across post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4). CONCLUSIONS: Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.


Assuntos
Qualidade de Vida/psicologia , Autoimagem , Estigma Social , Fístula Vaginal/psicologia , Saúde da Mulher , Adaptação Psicológica , Feminino , Humanos , Estudos Longitudinais , Fístula Retovaginal/psicologia , Uganda , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/psicologia
11.
J Forensic Dent Sci ; 11(3): 142-146, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32801586

RESUMO

Background: Age estimation is crucial in the identification of juveniles in conflicts with law, survivor of sexual assault, sportsperson, and civil cases. Aims: To estimate and compare the age (9-18 years) by dental and skeletal maturity in the Mumbai region. Settings and Design: This was a cross-sectional study. Materials and Methods: A total of 70 cases from 9 to 18 years of age were studied in 1 year in the urban population of the Mumbai region. Among 70 cases, 45 were males and 25 were females. Orthopantomogram and elbow joint radiographs were taken to assess the dental age through modified Demirjian's method and the radiological age through Sangma et al. staging method, respectively. Statistical Analysis: Data were analyzed using SPSS Statistics Version 26; descriptive statistics and regression statistics were used in the study. Results: Dental age by Demirjian's method in males with standard deviation was 15.25 (2.17), with a mean difference of 1.08 and significant P = 0.03. However, in females, dental age by Demirjian's method with standard deviation was 14.30 (1.94) with a mean difference of 0.74 and insignificant P = 0.07. Interclass correlation coefficient of dental age with chronological age, in males and females, showed 0.85 and 0.87 correlation, respectively. Correlation between the skeletal maturity and the dental age was reflected by the association of Demirjian stage 9 in the second molar with radiological stage 5 in males and stage 4 in females. Conclusions: It was concluded that Demirjian's method shows a significant correlation and P value for the age estimation in males of the Mumbai region.

12.
BMJ Open ; 8(9): e024216, 2018 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-30287614

RESUMO

OBJECTIVES: To describe trends in caesarean sections and facilities performing caesareans over time in Tanzania and examine the readiness of such facilities in terms of infrastructure, equipment and staffing. DESIGN: Nationally representative, repeated cross-sectional surveys of women and health facilities. SETTING: Tanzania. PARTICIPANTS: Women of reproductive age and health facility staff. MAIN OUTCOME MEASURES: Population-based caesarean rate, absolute annual number of caesareans, percentage of facilities reporting to perform caesareans and three readiness indicators for safe caesarean care: availability of consistent electricity, 24 hour schedule for caesarean and anaesthesia providers, and availability of all general anaesthesia equipment. RESULTS: The caesarean rate in Tanzania increased threefold from 2% in 1996 to 6% in 2015-16, while the total number of births increased by 60%. As a result, the absolute number of caesareans increased almost fivefold to 120 000 caesareans per year. The main mechanism sustaining the increase in caesareans was the doubling of median caesarean volume among public hospitals, from 17 caesareans per month in 2006 to 35 in 2014-15. The number of facilities performing caesareans increased only modestly over the same period. Less than half (43%) of caesareans in Tanzania in 2014-15 were performed in facilities meeting the three readiness indicators. Consistent electricity was widely available, and 24 hour schedules for caesarean and (less systematically) anaesthesia providers were observed in most facilities; however, the availability of all general anaesthesia equipment was the least commonly reported indicator, present in only 44% of all facilities (34% of public hospitals). CONCLUSIONS: Given the rising trend in numbers of caesareans, urgent improvements in the availability of general anaesthesia equipment and trained anaesthesia staff should be made to ensure the safety of caesareans. Initial efforts should focus on improving anaesthesia provision in public and faith-based organisation hospitals, which together perform more than 90% of all caesareans in Tanzania.


Assuntos
Anestesia Obstétrica , Atitude do Pessoal de Saúde , Cesárea , Serviços de Saúde Materna , Adulto , Anestesia Obstétrica/métodos , Anestesia Obstétrica/normas , Anestesia Obstétrica/estatística & dados numéricos , Cesárea/métodos , Cesárea/normas , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/organização & administração , Humanos , Masculino , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Gravidez , Melhoria de Qualidade/organização & administração , Tanzânia/epidemiologia
13.
Int Urogynecol J ; 29(10): 1509-1515, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29411073

RESUMO

INTRODUCTION AND HYPOTHESIS: There is a need for expanded access to safe surgical care in low- and middle-income countries (LMICs) as illustrated by the report of the 2015 Lancet Commission on Global Surgery. Packages of closely-related surgical procedures may create platforms of capacity that maximize impact in LMIC. Pelvic organ prolapse (POP) and genital fistula care provide an example. Although POP affects many more women in LMICs than fistula, donor support for fistula treatment in LMICs has been underway for decades, whereas treatment for POP is usually limited to hysterectomy-based surgical treatment, occurring with little to no donor support. This capacity-building discrepancy has resulted in POP care that is often non-adherent to international standards and in non-integration of POP and fistula services, despite clear areas of similarity and overlap. The objective of this study was to assess the feasibility and potential value of integrating POP services at fistula centers. METHODS: Fistula repair sites supported by the Fistula Care Plus project were surveyed on current demand for and capacity to provide POP, in addition to perceptions about integrating POP and fistula repair services. RESULTS: Respondents from 26 hospitals in sub-Saharan Africa and South Asia completed the survey. Most fistula centers (92%) reported demand for POP services, but many cannot meet this demand. Responses indicated a wide variation in assessment and grading practices for POP; approaches to lower urinary tract symptom evaluation; and surgical skills with regard to compartment-based POP, and urinary and rectal incontinence. Fistula surgeons identified integration synergies but also potential conflicts. CONCLUSIONS: Integration of genital fistula and POP services may enhance the quality of POP care while increasing the sustainability of fistula care.


Assuntos
Fortalecimento Institucional/métodos , Prestação Integrada de Cuidados de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Prolapso de Órgão Pélvico/terapia , Fístula Vaginal/terapia , Adulto , África ao Sul do Saara , Ásia Sudeste , Estudos de Viabilidade , Feminino , Recursos em Saúde , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários
14.
Trop Med Int Health ; 23(1): 106-119, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29140584

RESUMO

OBJECTIVE: The Demographic and Health Surveys (DHS), which include standardised questions on female genital fistula symptoms, provide a unique opportunity to evaluate the epidemiology of fistula. This study sought to examine associations between self-reported fistula symptoms and experience of gender-based violence (GBV) among women interviewed in DHS surveys. METHODS: This study used data from thirteen DHS surveys with standardised fistula and domestic violence modules. Data from the most recent survey in each country were pooled, weighting each survey equally. Multivariable logistic regressions controlled for maternal and demographic factors. RESULTS: Prevalence of fistula symptoms in this sample of 95 625 women ranges from 0.3% to 1.8% by country. The majority of women reporting fistula symptoms (56%) have ever experienced physical violence, and more than one-quarter have ever experienced sexual violence (27%), compared with 38% and 13% among women with no symptoms, respectively. Similarly, 16% of women with fistula symptoms report recently experiencing sexual violence-twice the percentage among women not reporting symptoms (8%). Women whose first experience of sexual violence was from a non-partner have almost four times the odds of reporting fistula symptoms compared with women who never experienced sexual violence. These associations indicate a need to investigate temporal and causal relationships between violence and fistula. CONCLUSIONS: The increased risk of physical and sexual violence among women with fistula symptoms suggests that fistula programmes should incorporate GBV into provider training and services.


Assuntos
Violência de Gênero/estatística & dados numéricos , Genitália Feminina/fisiopatologia , Delitos Sexuais/estatística & dados numéricos , Fístula Vaginal/diagnóstico , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Parceiros Sexuais , Fístula Vaginal/etiologia , Adulto Jovem
15.
Lancet Glob Health ; 5(11): e1152-e1160, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28941996

RESUMO

BACKGROUND: Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. METHODS: We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. FINDINGS: 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28·0 months (IQR 14·6-36·6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56·5-89·3) and an incidence proportion of 18·4% (14·8-22·8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23·1 per 1000 person-years (14·0-36·2), and corresponding to 10·3% (5·2-19·6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106·0 per 1000 person-years, corresponding to 28·4% (22·8-35·0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. INTERPRETATION: Recurrence of female genital fistula and adverse pregnancy-related maternal and child health outcomes were frequent in women after fistula repair in Guinea. Interventions are needed to safeguard the health of women after fistula repair. FUNDING: Belgian Development Cooperation (DGD), Institute of Tropical Medicine of Antwerp (ITM), and Maferinyah Training and Research Center in Rural Health (Guinea).


Assuntos
Parto , Taxa de Gravidez , Fístula Vaginal/epidemiologia , Fístula Vaginal/cirurgia , Adulto , Feminino , Guiné/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Gravidez , Recidiva , Resultado do Tratamento , Adulto Jovem
16.
Indian J Dent Res ; 27(5): 502-507, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27966508

RESUMO

CONTEXT: Both intraoral autogenous bone grafting (ABG) and platelet-rich fibrin (PRF) offer a useful treatment modality for periodontal regeneration of intrabony defects (IBDs). However, predictable regeneration in patients with severe attachment loss is a challenge to the practitioners. AIM: The aim of this study was to compare the clinical efficacy of PRF with ABG for the treatment of IBDs in chronic periodontitis. SETTINGS AND DESIGN: This is a randomized controlled trial. MATERIALS AND METHODS: Twenty chronic periodontitis patients with IBDs were randomly treated by PRF or ABG. Probing pocket depth (PPD), relative attachment level (RAL), surgical reentry bone fill, and radiographic bone fill (RBF) were recorded at baseline, 3, 6, and 9 months postsurgery, respectively. STATISTICAL ANALYSIS: Student's t-test was used for continuous variables. All means were expressed as mean ± standard deviation and proportions were expressed in percentage. The level of significance was set at P < 0.05. RESULTS: Both PRF and ABG sites produced a significant improvement from baseline to 9 months for all the parameters. However, there was no significant difference between the two treatment modalities in the reduction of PPD and RAL gain at 9 months. In addition, ABG showed significantly greater RBF (30.34%) as compared to PRF (20.22%). Similar findings were supported by surgical reentry, where a surgical reentry of 65.31% at ABG sites and 43.64% at PRF sites was seen. CONCLUSION: Both ABG and PRF can be used predictably to reconstruct lost periodontal structures as indicated by PPD reduction and RAL gain. However, in terms of osseous defect fill, ABG yields more definitive outcome than PRF.


Assuntos
Periodontite Crônica/cirurgia , Fibrina/uso terapêutico , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/cirurgia , Transplante Ósseo , Periodontite Crônica/diagnóstico por imagem , Humanos , Perda da Inserção Periodontal/diagnóstico por imagem , Perda da Inserção Periodontal/cirurgia , Plasma Rico em Plaquetas , Radiografia Dentária , Resultado do Tratamento
17.
Int J Gynaecol Obstet ; 132(2): 139-45, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26686027

RESUMO

BACKGROUND: Strengthening measurement of the quality of labor and delivery (L&D) care in low-resource countries requires an understanding of existing approaches. OBJECTIVES: To identify quantitative indicators of L&D care quality and assess gaps in indicators. SEARCH STRATEGY: PubMed, CINAHL Plus, and Embase databases were searched for research published in English between January 1, 1990, and October 31, 2013, using structured terms. SELECTION CRITERIA: Studies describing indicators for L&D care quality assessment were included. Those whose abstracts contained inclusion criteria underwent full-text review. DATA COLLECTION AND ANALYSIS: Study characteristics, including indicator selection and data sources, were extracted via a standard spreadsheet. MAIN RESULTS: The structured search identified 1224 studies. After abstract and full-text review, 477 were included in the analysis. Most studies selected indicators by using literature review, clinical guidelines, or expert panels. Few indicators were empirically validated; most studies relied on medical record review to measure indicators. CONCLUSIONS: Many quantitative indicators have been used to measure L&D care quality, but few have been validated beyond expert opinion. There has been limited use of clinical observation in quality assessment of care processes. The findings suggest the need for validated, efficient consensus indicators of the quality of L&D care processes, particularly in low-resource countries.


Assuntos
Parto Obstétrico/normas , Assistência Perinatal/normas , Indicadores de Qualidade em Assistência à Saúde , Países em Desenvolvimento , Feminino , Humanos , Trabalho de Parto , Gravidez
18.
Bull World Health Organ ; 93(11): 759-67, 2015 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-26549903

RESUMO

OBJECTIVE: To assess the quality of facility-based active management of the third stage of labour in Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and the United Republic of Tanzania. METHODS: Between 2009 and 2012, using a cross-sectional design, 2317 women in 390 health facilities were directly observed during the third stage of labour. Observers recorded the use of uterotonic medicines, controlled cord traction and uterine massage. Facility infrastructure and supplies needed for active management were audited and relevant guidelines reviewed. FINDINGS: Most (94%; 2173) of the women observed were given oxytocin (2043) or another uterotonic (130). The frequencies of controlled cord traction and uterine massage and the timing of uterotonic administration showed considerable between-country variation. Of the women given a uterotonic, 1640 (76%) received it within three minutes of the birth. Uterotonics and related supplies were generally available onsite. Although all of the study countries had national policies and/or guidelines that supported the active management of the third stage of labour, the presence of guidelines in facilities varied across countries and only 377 (36%) of 1037 investigated providers had received relevant training in the previous three years. CONCLUSION: In the study countries, quality and coverage of the active management of the third stage of labour were high. However, to improve active management, there needs to be more research on optimizing the timing of uterotonic administration. Training on the use of new clinical guidelines and implementation research on the best methods to update such training are also needed.


Assuntos
Parto Obstétrico/métodos , Parto Obstétrico/normas , Terceira Fase do Trabalho de Parto , Qualidade da Assistência à Saúde , África ao Sul do Saara , África Oriental , Estudos Transversais , Feminino , Humanos , Trabalho de Parto , Madagáscar , Tocologia , Moçambique , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Médicos , Guias de Prática Clínica como Assunto , Gravidez
19.
BMC Infect Dis ; 15: 349, 2015 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-26286724

RESUMO

BACKGROUND: Avahan, a large-scale HIV prevention program in India, transitioned over 130 intervention sites from donor funding and management to government ownership in three rounds. This paper examines the transition experience from the perspective of the communities targeted by these interventions. METHODS: Fifteen qualitative longitudinal case studies were conducted across all three rounds of transition, including 83 in-depth interviews and 45 focus group discussions. Data collection took place between 2010 and 2013 in four states: Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu. RESULTS: We find that communication about transition was difficult at first but improved over time, while issues related to employment of peer educators were challenging throughout the transition. Clinical services were shifted to government providers resulting in mixed experiences depending on the population being targeted. Lastly, the loss of activities aimed at community ownership and mobilization negatively affected the beneficiaries' view of transition. CONCLUSIONS: While some programmatic changes resulted in improvements, additional opportunity costs for beneficiaries may pose barriers to accessing HIV prevention services. Communicating and engaging community stakeholders early on in future such transitions may mitigate negative feelings and lead to more constructive relationships and dialogue.


Assuntos
Assistência à Saúde/economia , Financiamento Governamental , Fundações , Infecções por HIV/prevenção & controle , Promoção da Saúde/economia , Financiamento da Assistência à Saúde , Assistência à Saúde/organização & administração , Grupos Focais , Promoção da Saúde/organização & administração , Humanos , Índia , Estudos Longitudinais , Pesquisa Qualitativa
20.
PLoS One ; 10(6): e0129491, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26107655

RESUMO

BACKGROUND: High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions. METHODS AND FINDINGS: Global maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar). A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries. CONCLUSIONS: As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined, comprehensive, and validated index may enable ongoing and efficient observation-based assessment of care quality during labor and delivery in sub-Saharan Africa, facilitating targeted quality improvement.


Assuntos
Parto Obstétrico , Trabalho de Parto , Assistência Perinatal/organização & administração , Assistência Perinatal/normas , Qualidade da Assistência à Saúde , África ao Sul do Saara , Área Sob a Curva , Feminino , Humanos , Recém-Nascido , Cooperação Internacional , Quênia , Madagáscar , Obstetrícia/normas , Gravidez , Probabilidade , Desenvolvimento de Programas , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde , Curva ROC , Tanzânia
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