Francophone countries in sub-Saharan Africa had been more resistant to induced abortion.Their cultural heritage from France had been influential in strengthening their pronatalist position regarding contraception and ...Francophone countries in sub-Saharan Africa had been more resistant to induced abortion.Their cultural heritage from France had been influential in strengthening their pronatalist position regarding contraception and abortion.Most of them inherited the judicial system and cultural value from France,which have been transmitted to Francophone countries.However,cultural and behavioral changes in reproductive health have begun in Francophone sub-Saharan Africa since the mid-1990s after the paradigm shift on population policy with the International Conference on Population and Development(ICPD)in 1994.Some women have started to use contraception for birth limitation.Induced abortion to prevent unintended pregnancy has been increasingly liberalized in some settings.In this study,the changing contexts for induced abortion in Francophone countries will be reviewed.Recent step undertaken by Benin to legalize abortion in most circumstances shows that Francophone countries may be overcoming their cultural barriers and adapting universal human rights based reproductive behaviors.展开更多
Objective: The purpose of this trial was to determine whether calcium supplementation of pregnant women with low calcium intake reduces preeclampsia and preterm delivery. Study design: Randomized placebo- controlled, ...Objective: The purpose of this trial was to determine whether calcium supplementation of pregnant women with low calcium intake reduces preeclampsia and preterm delivery. Study design: Randomized placebo- controlled, double- blinded trial in nulliparous normotensive women from populations with dietary calcium < 600 mg/d. Women who were recruited before gestational week 20 received supplements (1.5 g calcium/d or placebo) through-out pregnancy. Primary outcomes were preeclampsia and preterm delivery; secondary outcomes focused on severe morbidity and maternal and neonatal mortality rates. Results: The groups comprised 8325 women who were assigned randomly. Both groups had similar gestational ages, demographic characteristics, and blood pressure levels at entry. Compliance were both 85% and follow- up losses (calcium, 3.4% ; placebo, 3.7% ). Calcium supplementation was associated with a non- statistically significant small reduction in preeclampsia (4.1% vs 4.5% ) that was evident by 35 weeks of gestation (1.2% vs 2.8% ; P = .04). Eclampsia (risk ratio, 0.68: 95% CI, 0.48- 0.97) and severe gestational hypertension (risk ratio, 0.71; 95% CI, 0.61- 0.82) were significantly lower in the calcium group. Overall, there was a reduction in the severe preeclamptic complications index (risk ratio, 0.76; 95% CI, 0.66- 0.89; life- table analysis, log rank test; P = .04). The severe maternal morbidity and mortality index was also reduced in the supplementation group (risk ratio, 0.80; 95% CI, 0.70- 0.91). Preterm delivery (the neonatal primary outcome) and early preterm delivery tended to be reduced among women who were ≤ 20 years of age (risk ratio, 0.82; 95% CI, 0.67- 1.01; risk ratio, 0.64; 95% CI, 0.42- 0.98, respectively). The neonatal mortality rate was lower (risk ratio, 0.70; 95% CI, 0.56- 0.88) in the calcium group. Conclusion: A 1.5 g calcium/day supplement did not prevent preeclampsia but did reduce its severity, maternal morbidity, and neonatal mortality, albeit these were secondary outcomes.展开更多
<p> <b><span style="font-family:Verdana;">Introduction: </span></b><span style="font-family:""><span style="font-family:Verdana;">Female gen...<p> <b><span style="font-family:Verdana;">Introduction: </span></b><span style="font-family:""><span style="font-family:Verdana;">Female genital fistula (FGF), remains a world concern, especially in low developed country. Obstructive (blocked) delivery labor is his principal cause, sometimes by pelvic surgery (urogenital or obstetrical, rectal) more rarely by congenital urogenital malformation, excision, pelvic neoplasm, pelvic radiotherapy. We were interested in iatrogenic FGF treated in the special referral fistula center. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">We report 35 cases of iatrogenic female genital fistula. Are included only cases by urogenital surgery, excision in the National Referal Center of Obstetrical Fistula. Were not included cases happened by over 12 hours blocked delivery labor, caustic destruction, pelvic cancer pelvic infection and those with incomplete file. The epidemiologic, clinical and therapeutic information were studied. All ethical protocols were respected. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">CNRFO recorded 743 cases of female genital fistula from May 23 2013 to May 23 May 2018 within 35 iatrogenic cases (4.71%). Patients were 19 - 29 years old (42.85%), average age 35 years old, extremes 19 - 60 years, without occupation (82.86), grand multiparous 48.57%, with a mean of 4 previous deliveries. The principal constancies were hysterectomies 71.43%, caesarean section 17.14%, genital excision 11.42%, and cystocele cure 11.42%. The anatomical finds were soft vagina tissue 97.14% uretero-vaginal fistula 45.71% (2 cases post Caesarean, 14 cases post hysterectomy), vesico-vaginal 31.43% (all post hysterectomy), ureteral 11.42% (all post caesarean), 1 vesico-uterine 5.71% (case post caesarean), 1 case after a cystocele cure, 2 uretro-vaginal 11.42% secondary of genital excision. Treatment was ureteral reimplantation (18/31) cases by abdominal way, fistulorraphy (12/31) and 1uretroplasty by vaginal, 4 cases treated with transurethral bladder probe. 30 were cured by fistulas surgery, 1 urinary tress incontinency and 1 not closed, and 4 of transurethral bladder probe were cured. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The female genital fistula is sometimes the consequence of Caesarean, hysterectomy, gynecological surgery, urologic surgery and some traditional practices.</span></span> </p>展开更多
Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effectiv...Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published </span><span style="font-family:Verdana;">during</span><span style="font-family:Verdana;"> 2000-2018. The following databases were searched</span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable</span><span style="font-family:""> </span><span style="font-family:Verdana;">effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.展开更多
Introduction: We report anatomopathological and treatment results of new cases of obstetrical female genital fistula in main to determine the prognosis. Methodology: Multicentre prospective study over 15 months (Janua...Introduction: We report anatomopathological and treatment results of new cases of obstetrical female genital fistula in main to determine the prognosis. Methodology: Multicentre prospective study over 15 months (January 1st, 2016 to March 31st, 2017) in 5 national centres of female genital fistula treatment. Patients were in all age group. Anatomopathological types were urogenital classified simple, middle and mixte (association of urogenital and recto genital). The methods of treatment were surgery and trans uretral vesical probe. We observed treated patients during 3 months. Results: 148 new cases collected. The study revealed 47.15% of urogenital fistulas were vesico-vaginal and urethro-vaginal (25.71%). 3 cases of rectovaginal fistula including 2 cases in the lower third of the rectum and one in the upper third, 141 patients were treated. The results gave 35 cases treated by trans ureterovesical probe cured and dry, those by surgery were continent and dry (71.62%) but 23 (15.54%) treated but not dry, 12 (4.10%) FGF were not closed tTab5) 7 cases not treated, one referred to urology service, one patient died before treatment and 5 perdu of view. Conclusion: Obstetric fistula remains a serious public health problem in Niger. FGF happened in all age old because of non skilled pre- and per-natal care particularly in rural area. Treatment could be improved but political prevention must be the rule.展开更多
To successfully adjust to an aging world,the needs of older people should be addressed with a sustainable social security system in place,which also address inequities in aging.this growing demographic population.In 2...To successfully adjust to an aging world,the needs of older people should be addressed with a sustainable social security system in place,which also address inequities in aging.this growing demographic population.In 2002,GLOBALLY - by 2050 - there will be 2.1 billion people over the age of 60. Populations are aging at a faster pace than ever before, requiring governments to adapt more quickly to this demographic shift than in the past.展开更多
Introduction: Obstetric fistula is a public health problem but its prevalence remains unknown in Niger. We report epidemiological and anatomopathological status of new cases of female genital fistula. Method: Multicen...Introduction: Obstetric fistula is a public health problem but its prevalence remains unknown in Niger. We report epidemiological and anatomopathological status of new cases of female genital fistula. Method: Multicentre prospective study over 15 months (January 1st, 2016 to March 31st, 2017) in 5 national centers for the therapeutic management of female genital fistula. Data were collected from focus groups, observations and pre-established individual survey form and hospital records. Results: During the 15-month survey period, 148 new cases of female genital fistula of obstetric origin were recorded. Patients aged 15 to 19 accounted for 40% of cases. They were married before the age of 16 (55.4%), out of school in 89.2% and 77.2% lived outside the matrimonial home. The patients came from rural areas (96%) of the cases, the labor of delivery lasted more than 24 hours in 71.6% and in 95.3% of the cases the delivery was initiated at home and then finished in a health facility, 33.8% had assisted vaginal delivery (forceps/suction cup), 23% by caesarean section and 10.81% by laparotomy for uterine rupture. Fistula occurred during first delivery (47.3%) and recurrence accounted for 5.4% of cases. Perinatal death accounted for 85.1%. Conclusion: Female genital fistula of obstetric origin remains a major public health problem in Niger despite the efforts made.展开更多
Background: In the world, induced abortion constitutes a preponderant cause of morbidity and maternal mortality, more particularly in developing countries. In these countries, the prevalence of contraception remains l...Background: In the world, induced abortion constitutes a preponderant cause of morbidity and maternal mortality, more particularly in developing countries. In these countries, the prevalence of contraception remains low, and situation makes the bed of unwanted pregnancies leading easily to the induced abortions. The objective was to determine frequency of clandestine induced abortions and to know the motivations of women that practice these abortions in order to find a solution to minimize this practice. Patients and method: We conducted a prospective, descriptive and multicenter survey for three months from November 1st, 2015 to January 31st, 2016 achieved at N’Djamena Mother and Child hospital which is national reference structure in terms reproduction health, Moundou Regional Hospital and Abéché Regional Hospital about the epidemiological aspects and complications clandestine induced abortions. The population of survey was constituted of patients admitted in a maternity of these hospitals for clandestine induced abortion. Every patient having practiced a documented induced abortion and having agreed to participate in the survey was included. Results: During the survey period, we recorded 94 cases of clandestine induced abortions among 2759 deliveries giving a frequency of 3.4%. The age group between 20 - 24 years was the most represented with 42.7%. The average age was 25.4 years, with the extremes ranging from 15 to 42 years. Singles (66%) dominated marital status. Sixty patients (63.9%) were of secondary. These patients were for the most part students or pupils (55.3%). Concerning the parity, nulliparous were the most numerous to practice the abortion (40.5%). More than half our patients (58.7%) knew no contraceptive method. The principal reason evoked to realize the abortion was further studies (38.2%). Means of abortion most used was the misoprostol (36 cases that is 38.2%). In this series, we observed 29 cases of complications, which is 30.8%. The complications were dominated by the anaemia (62.1%). Conclusion: The clandestine induced abortion is a frequent situation in the Chad and is cause of numerous complications.展开更多
Background: The incidence of cervical cancer is high in Bangladesh and there is a high prevalence of preinvasive lower genital tract disease among women of reproductive age. Persistent high-risk Human Papilloma Virus ...Background: The incidence of cervical cancer is high in Bangladesh and there is a high prevalence of preinvasive lower genital tract disease among women of reproductive age. Persistent high-risk Human Papilloma Virus (HPV) infection is the main underlying cause of cervical cancer and its precursor, cervical intraepithelial neoplasia (CIN). Objective: The aim of the study was to identify the subtypes of high-risk HPV infection among women with the colposcopic diagnosis of cervical intraepithelial neoplasia in Bangladesh. Methods: This cross-sectional observational study was conducted in the colposcopy clinic of Dhaka Medical College Hospital over a six-month period. A total of 100 participants were enrolled. Married women, between 30 - 60 years of age with colposcopically diagnosed cervical intra epithelial neoplasia were enrolled. Women with chronic illness, pregnancy, and women unable to consent were excluded from this study. After counselling, colposcopically directed punch biopsies were taken from each CIN case concurrently with high-risk HPV testing by polymerase chain reaction (PCR). Results: The mean age of the patients was 38.69 (SD ±7.76) years. CIN 1 was diagnosed in 57% of participants, while 24% had CIN II and 19% had CIN III lesions. High-risk HPV was present in 52 patients. HPV 16 was the most common identified in 28 (53.84%) and HPV 18 was the second most common with 20 (38.46%) either singly or in combination with other high-risk subtypes. The other HPV strains, HPV 31, 33, 35, 52, 56 and 58, were also detected either as mono or co-infections. Out of the 52 HPV positive cases, 29 (55.8%) had mono infection and 23 (44.2%) had co-infection with several subtypes. The highest incidence (50%) of oncogenic HPV infections was present among women aged 35 - 45 years. Risk factors associated with HPV positive cases were high parity (P 0.05), early age at marriage (P = 0.754) and early age of first child. Conclusion: This study identified a high prevalence of HPV 16 and 18 genotypes. HPV vaccination with the current 9-valent HPV vaccine, which contains HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Will be an effective public health measure to eradicate cervical cancer in Bangladesh.展开更多
OBJECTIVE: Our aim was to document the differential neonatal morbidity and intrapartum and neonatal mortality of subgroups of preterm delivery. METHODS: This analysis included 38,319 singleton pregnancies, of which 3,...OBJECTIVE: Our aim was to document the differential neonatal morbidity and intrapartum and neonatal mortality of subgroups of preterm delivery. METHODS: This analysis included 38,319 singleton pregnancies, of which 3,304 (8.6%)-were preterm deliveries (less than 37 completed weeks) enrolled in the World Health Organization randomized trial of a new antenatal care model. We classified them as preterm deliveries after spontaneous initiation of labor, either with or without maternal obstetric and medical complications; preterm deliveries after prelabor spontaneous rupture of amniotic membranes (PROM), either with or without obstetric and medical complications; and medically indicated preterm deliveries with maternal obstetric and medical complications. Severe neonatal morbidity and neonatal mortality were the primary outcomes. RESULTS: Fifty-six percent of all preterm deliveries were spontaneous, without maternal complications. Small for gestational age was increased only among the medically indicated preterm delivery group (22.3%). Very early preterm delivery (less than 32 weeks of gestation) was highest among PROM with complications (37%). For intrapartum fetal death and neonatal death, after adjusting by gestational age and other confounding variables, we found that the obstetric and medical complications preceding preterm delivery predicted the different risk levels. Conversely, for severe neonatal morbidity the clinical presentation, ie, PROM or medically indicated, predicted the increased risk. CONCLUSION: There are differential neonatal outcomes among preterm deliveries according to clinical presentation, pregnancy complications, gestational age at delivery, and its association with small for gestational age. This syndromic nature of the condition should be considered if preterm delivery is to be fully understood and thus reduced.展开更多
Objective: To report the experience of surgical caravans for urogenital fistulas care. Methodology: This was a retrospective study covering the period from January 2014 to December 2014 and which took place on 7 sites...Objective: To report the experience of surgical caravans for urogenital fistulas care. Methodology: This was a retrospective study covering the period from January 2014 to December 2014 and which took place on 7 sites of fistula care. The epidemiological, anatomoclinical, therapeutic and evolutionary aspects were studied. Results: 346 patients were operated during 14 caravans. Their average age was 33.11 years (range: 12 to 70 years). Most of these patients were without remunerative activities (80%) and without education (63.3%). The average duration of fistula progression was 6.08 years (range: 0 to 42 years). Obstetrical etiology was predominant (87.9%). According to the classification of Kees Waaldijk, fistulas were divided into type I (67.4%), type II (21.1%), and type III (11.5%). The most common surgical approach was the transvaginal route (82.1%). The vesicovaginal splitting with separated suture of the bladder and the vagina was the basic technique (94.7%). The therapeutic results were judged after a follow-up of 1 month and 3 months. Across the cohort, 80 patients (23.1%) were lost of sight for follow-up at 1 month and 245 (70%) at 3 months. The success rates evaluated in patients reviewed at 1 month and 3 months were respectively 70% and 64%. Conclusion: The incidence of urogenital fistulas is still high in Cote d'Ivoire. Various anatomoclinical varieties have been identified and treated with satisfactory results in poorly equipped local structures.展开更多
The UNFPA 2022 State of the World Population(SWOP)report recognises that certain populations of young women and girls are at a higher risk of unintended pregnancy,but did not adequately address the grave situation of ...The UNFPA 2022 State of the World Population(SWOP)report recognises that certain populations of young women and girls are at a higher risk of unintended pregnancy,but did not adequately address the grave situation of female sex workers(FSWs),who experience the worst sexual and reproductive health outcomes,especially during humanitarian crises.This study assesses the risks of unintended pregnancy among FSWs and sex worker organizations?response during the stringent COVID-19 containment measures in East and Southern Africa(ESA).A mixed-methods approach consisting of a desk review,key informant interviews and an online survey was used for data collection.Key informants and survey respondents included representatives of sex worker-led organisations and networks,organisations providing services to sex workers,development partners,advocacy organisations and donors,with priority given to key informants who had direct experience of providing services to sex workers during the COVID-19 pandemic.In total,21 key informants were interviewed and 69 respondents participated in the online survey,with representation from 14 out of 23 countries in the ESA region.The study findings show that the disruption to livelihoods and threats to human rights occasioned by the stringent COVID-19 containment measures intersected with sex workers’access to contraception and risk of unintended pregnancy.Looking to the uncertain future of humanitarian crises,the study concludes by outlining critical issues that need to be addressed to ensure resilience of SRHR services for populations in vulnerable positions,such as sex workers.展开更多
文摘Francophone countries in sub-Saharan Africa had been more resistant to induced abortion.Their cultural heritage from France had been influential in strengthening their pronatalist position regarding contraception and abortion.Most of them inherited the judicial system and cultural value from France,which have been transmitted to Francophone countries.However,cultural and behavioral changes in reproductive health have begun in Francophone sub-Saharan Africa since the mid-1990s after the paradigm shift on population policy with the International Conference on Population and Development(ICPD)in 1994.Some women have started to use contraception for birth limitation.Induced abortion to prevent unintended pregnancy has been increasingly liberalized in some settings.In this study,the changing contexts for induced abortion in Francophone countries will be reviewed.Recent step undertaken by Benin to legalize abortion in most circumstances shows that Francophone countries may be overcoming their cultural barriers and adapting universal human rights based reproductive behaviors.
文摘Objective: The purpose of this trial was to determine whether calcium supplementation of pregnant women with low calcium intake reduces preeclampsia and preterm delivery. Study design: Randomized placebo- controlled, double- blinded trial in nulliparous normotensive women from populations with dietary calcium < 600 mg/d. Women who were recruited before gestational week 20 received supplements (1.5 g calcium/d or placebo) through-out pregnancy. Primary outcomes were preeclampsia and preterm delivery; secondary outcomes focused on severe morbidity and maternal and neonatal mortality rates. Results: The groups comprised 8325 women who were assigned randomly. Both groups had similar gestational ages, demographic characteristics, and blood pressure levels at entry. Compliance were both 85% and follow- up losses (calcium, 3.4% ; placebo, 3.7% ). Calcium supplementation was associated with a non- statistically significant small reduction in preeclampsia (4.1% vs 4.5% ) that was evident by 35 weeks of gestation (1.2% vs 2.8% ; P = .04). Eclampsia (risk ratio, 0.68: 95% CI, 0.48- 0.97) and severe gestational hypertension (risk ratio, 0.71; 95% CI, 0.61- 0.82) were significantly lower in the calcium group. Overall, there was a reduction in the severe preeclamptic complications index (risk ratio, 0.76; 95% CI, 0.66- 0.89; life- table analysis, log rank test; P = .04). The severe maternal morbidity and mortality index was also reduced in the supplementation group (risk ratio, 0.80; 95% CI, 0.70- 0.91). Preterm delivery (the neonatal primary outcome) and early preterm delivery tended to be reduced among women who were ≤ 20 years of age (risk ratio, 0.82; 95% CI, 0.67- 1.01; risk ratio, 0.64; 95% CI, 0.42- 0.98, respectively). The neonatal mortality rate was lower (risk ratio, 0.70; 95% CI, 0.56- 0.88) in the calcium group. Conclusion: A 1.5 g calcium/day supplement did not prevent preeclampsia but did reduce its severity, maternal morbidity, and neonatal mortality, albeit these were secondary outcomes.
文摘<p> <b><span style="font-family:Verdana;">Introduction: </span></b><span style="font-family:""><span style="font-family:Verdana;">Female genital fistula (FGF), remains a world concern, especially in low developed country. Obstructive (blocked) delivery labor is his principal cause, sometimes by pelvic surgery (urogenital or obstetrical, rectal) more rarely by congenital urogenital malformation, excision, pelvic neoplasm, pelvic radiotherapy. We were interested in iatrogenic FGF treated in the special referral fistula center. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">We report 35 cases of iatrogenic female genital fistula. Are included only cases by urogenital surgery, excision in the National Referal Center of Obstetrical Fistula. Were not included cases happened by over 12 hours blocked delivery labor, caustic destruction, pelvic cancer pelvic infection and those with incomplete file. The epidemiologic, clinical and therapeutic information were studied. All ethical protocols were respected. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">CNRFO recorded 743 cases of female genital fistula from May 23 2013 to May 23 May 2018 within 35 iatrogenic cases (4.71%). Patients were 19 - 29 years old (42.85%), average age 35 years old, extremes 19 - 60 years, without occupation (82.86), grand multiparous 48.57%, with a mean of 4 previous deliveries. The principal constancies were hysterectomies 71.43%, caesarean section 17.14%, genital excision 11.42%, and cystocele cure 11.42%. The anatomical finds were soft vagina tissue 97.14% uretero-vaginal fistula 45.71% (2 cases post Caesarean, 14 cases post hysterectomy), vesico-vaginal 31.43% (all post hysterectomy), ureteral 11.42% (all post caesarean), 1 vesico-uterine 5.71% (case post caesarean), 1 case after a cystocele cure, 2 uretro-vaginal 11.42% secondary of genital excision. Treatment was ureteral reimplantation (18/31) cases by abdominal way, fistulorraphy (12/31) and 1uretroplasty by vaginal, 4 cases treated with transurethral bladder probe. 30 were cured by fistulas surgery, 1 urinary tress incontinency and 1 not closed, and 4 of transurethral bladder probe were cured. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The female genital fistula is sometimes the consequence of Caesarean, hysterectomy, gynecological surgery, urologic surgery and some traditional practices.</span></span> </p>
文摘Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published </span><span style="font-family:Verdana;">during</span><span style="font-family:Verdana;"> 2000-2018. The following databases were searched</span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable</span><span style="font-family:""> </span><span style="font-family:Verdana;">effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.
文摘Introduction: We report anatomopathological and treatment results of new cases of obstetrical female genital fistula in main to determine the prognosis. Methodology: Multicentre prospective study over 15 months (January 1st, 2016 to March 31st, 2017) in 5 national centres of female genital fistula treatment. Patients were in all age group. Anatomopathological types were urogenital classified simple, middle and mixte (association of urogenital and recto genital). The methods of treatment were surgery and trans uretral vesical probe. We observed treated patients during 3 months. Results: 148 new cases collected. The study revealed 47.15% of urogenital fistulas were vesico-vaginal and urethro-vaginal (25.71%). 3 cases of rectovaginal fistula including 2 cases in the lower third of the rectum and one in the upper third, 141 patients were treated. The results gave 35 cases treated by trans ureterovesical probe cured and dry, those by surgery were continent and dry (71.62%) but 23 (15.54%) treated but not dry, 12 (4.10%) FGF were not closed tTab5) 7 cases not treated, one referred to urology service, one patient died before treatment and 5 perdu of view. Conclusion: Obstetric fistula remains a serious public health problem in Niger. FGF happened in all age old because of non skilled pre- and per-natal care particularly in rural area. Treatment could be improved but political prevention must be the rule.
文摘To successfully adjust to an aging world,the needs of older people should be addressed with a sustainable social security system in place,which also address inequities in aging.this growing demographic population.In 2002,GLOBALLY - by 2050 - there will be 2.1 billion people over the age of 60. Populations are aging at a faster pace than ever before, requiring governments to adapt more quickly to this demographic shift than in the past.
文摘Introduction: Obstetric fistula is a public health problem but its prevalence remains unknown in Niger. We report epidemiological and anatomopathological status of new cases of female genital fistula. Method: Multicentre prospective study over 15 months (January 1st, 2016 to March 31st, 2017) in 5 national centers for the therapeutic management of female genital fistula. Data were collected from focus groups, observations and pre-established individual survey form and hospital records. Results: During the 15-month survey period, 148 new cases of female genital fistula of obstetric origin were recorded. Patients aged 15 to 19 accounted for 40% of cases. They were married before the age of 16 (55.4%), out of school in 89.2% and 77.2% lived outside the matrimonial home. The patients came from rural areas (96%) of the cases, the labor of delivery lasted more than 24 hours in 71.6% and in 95.3% of the cases the delivery was initiated at home and then finished in a health facility, 33.8% had assisted vaginal delivery (forceps/suction cup), 23% by caesarean section and 10.81% by laparotomy for uterine rupture. Fistula occurred during first delivery (47.3%) and recurrence accounted for 5.4% of cases. Perinatal death accounted for 85.1%. Conclusion: Female genital fistula of obstetric origin remains a major public health problem in Niger despite the efforts made.
文摘Background: In the world, induced abortion constitutes a preponderant cause of morbidity and maternal mortality, more particularly in developing countries. In these countries, the prevalence of contraception remains low, and situation makes the bed of unwanted pregnancies leading easily to the induced abortions. The objective was to determine frequency of clandestine induced abortions and to know the motivations of women that practice these abortions in order to find a solution to minimize this practice. Patients and method: We conducted a prospective, descriptive and multicenter survey for three months from November 1st, 2015 to January 31st, 2016 achieved at N’Djamena Mother and Child hospital which is national reference structure in terms reproduction health, Moundou Regional Hospital and Abéché Regional Hospital about the epidemiological aspects and complications clandestine induced abortions. The population of survey was constituted of patients admitted in a maternity of these hospitals for clandestine induced abortion. Every patient having practiced a documented induced abortion and having agreed to participate in the survey was included. Results: During the survey period, we recorded 94 cases of clandestine induced abortions among 2759 deliveries giving a frequency of 3.4%. The age group between 20 - 24 years was the most represented with 42.7%. The average age was 25.4 years, with the extremes ranging from 15 to 42 years. Singles (66%) dominated marital status. Sixty patients (63.9%) were of secondary. These patients were for the most part students or pupils (55.3%). Concerning the parity, nulliparous were the most numerous to practice the abortion (40.5%). More than half our patients (58.7%) knew no contraceptive method. The principal reason evoked to realize the abortion was further studies (38.2%). Means of abortion most used was the misoprostol (36 cases that is 38.2%). In this series, we observed 29 cases of complications, which is 30.8%. The complications were dominated by the anaemia (62.1%). Conclusion: The clandestine induced abortion is a frequent situation in the Chad and is cause of numerous complications.
文摘Background: The incidence of cervical cancer is high in Bangladesh and there is a high prevalence of preinvasive lower genital tract disease among women of reproductive age. Persistent high-risk Human Papilloma Virus (HPV) infection is the main underlying cause of cervical cancer and its precursor, cervical intraepithelial neoplasia (CIN). Objective: The aim of the study was to identify the subtypes of high-risk HPV infection among women with the colposcopic diagnosis of cervical intraepithelial neoplasia in Bangladesh. Methods: This cross-sectional observational study was conducted in the colposcopy clinic of Dhaka Medical College Hospital over a six-month period. A total of 100 participants were enrolled. Married women, between 30 - 60 years of age with colposcopically diagnosed cervical intra epithelial neoplasia were enrolled. Women with chronic illness, pregnancy, and women unable to consent were excluded from this study. After counselling, colposcopically directed punch biopsies were taken from each CIN case concurrently with high-risk HPV testing by polymerase chain reaction (PCR). Results: The mean age of the patients was 38.69 (SD ±7.76) years. CIN 1 was diagnosed in 57% of participants, while 24% had CIN II and 19% had CIN III lesions. High-risk HPV was present in 52 patients. HPV 16 was the most common identified in 28 (53.84%) and HPV 18 was the second most common with 20 (38.46%) either singly or in combination with other high-risk subtypes. The other HPV strains, HPV 31, 33, 35, 52, 56 and 58, were also detected either as mono or co-infections. Out of the 52 HPV positive cases, 29 (55.8%) had mono infection and 23 (44.2%) had co-infection with several subtypes. The highest incidence (50%) of oncogenic HPV infections was present among women aged 35 - 45 years. Risk factors associated with HPV positive cases were high parity (P 0.05), early age at marriage (P = 0.754) and early age of first child. Conclusion: This study identified a high prevalence of HPV 16 and 18 genotypes. HPV vaccination with the current 9-valent HPV vaccine, which contains HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Will be an effective public health measure to eradicate cervical cancer in Bangladesh.
文摘OBJECTIVE: Our aim was to document the differential neonatal morbidity and intrapartum and neonatal mortality of subgroups of preterm delivery. METHODS: This analysis included 38,319 singleton pregnancies, of which 3,304 (8.6%)-were preterm deliveries (less than 37 completed weeks) enrolled in the World Health Organization randomized trial of a new antenatal care model. We classified them as preterm deliveries after spontaneous initiation of labor, either with or without maternal obstetric and medical complications; preterm deliveries after prelabor spontaneous rupture of amniotic membranes (PROM), either with or without obstetric and medical complications; and medically indicated preterm deliveries with maternal obstetric and medical complications. Severe neonatal morbidity and neonatal mortality were the primary outcomes. RESULTS: Fifty-six percent of all preterm deliveries were spontaneous, without maternal complications. Small for gestational age was increased only among the medically indicated preterm delivery group (22.3%). Very early preterm delivery (less than 32 weeks of gestation) was highest among PROM with complications (37%). For intrapartum fetal death and neonatal death, after adjusting by gestational age and other confounding variables, we found that the obstetric and medical complications preceding preterm delivery predicted the different risk levels. Conversely, for severe neonatal morbidity the clinical presentation, ie, PROM or medically indicated, predicted the increased risk. CONCLUSION: There are differential neonatal outcomes among preterm deliveries according to clinical presentation, pregnancy complications, gestational age at delivery, and its association with small for gestational age. This syndromic nature of the condition should be considered if preterm delivery is to be fully understood and thus reduced.
文摘Objective: To report the experience of surgical caravans for urogenital fistulas care. Methodology: This was a retrospective study covering the period from January 2014 to December 2014 and which took place on 7 sites of fistula care. The epidemiological, anatomoclinical, therapeutic and evolutionary aspects were studied. Results: 346 patients were operated during 14 caravans. Their average age was 33.11 years (range: 12 to 70 years). Most of these patients were without remunerative activities (80%) and without education (63.3%). The average duration of fistula progression was 6.08 years (range: 0 to 42 years). Obstetrical etiology was predominant (87.9%). According to the classification of Kees Waaldijk, fistulas were divided into type I (67.4%), type II (21.1%), and type III (11.5%). The most common surgical approach was the transvaginal route (82.1%). The vesicovaginal splitting with separated suture of the bladder and the vagina was the basic technique (94.7%). The therapeutic results were judged after a follow-up of 1 month and 3 months. Across the cohort, 80 patients (23.1%) were lost of sight for follow-up at 1 month and 245 (70%) at 3 months. The success rates evaluated in patients reviewed at 1 month and 3 months were respectively 70% and 64%. Conclusion: The incidence of urogenital fistulas is still high in Cote d'Ivoire. Various anatomoclinical varieties have been identified and treated with satisfactory results in poorly equipped local structures.
文摘The UNFPA 2022 State of the World Population(SWOP)report recognises that certain populations of young women and girls are at a higher risk of unintended pregnancy,but did not adequately address the grave situation of female sex workers(FSWs),who experience the worst sexual and reproductive health outcomes,especially during humanitarian crises.This study assesses the risks of unintended pregnancy among FSWs and sex worker organizations?response during the stringent COVID-19 containment measures in East and Southern Africa(ESA).A mixed-methods approach consisting of a desk review,key informant interviews and an online survey was used for data collection.Key informants and survey respondents included representatives of sex worker-led organisations and networks,organisations providing services to sex workers,development partners,advocacy organisations and donors,with priority given to key informants who had direct experience of providing services to sex workers during the COVID-19 pandemic.In total,21 key informants were interviewed and 69 respondents participated in the online survey,with representation from 14 out of 23 countries in the ESA region.The study findings show that the disruption to livelihoods and threats to human rights occasioned by the stringent COVID-19 containment measures intersected with sex workers’access to contraception and risk of unintended pregnancy.Looking to the uncertain future of humanitarian crises,the study concludes by outlining critical issues that need to be addressed to ensure resilience of SRHR services for populations in vulnerable positions,such as sex workers.
