Facing medical care problems of victims of sexual violence in Goma/Eastern Democratic Republic of the Congo

<p>Abstract</p> <p>Background</p> <p>Since 1998, the Eastern Democratic Republic of the Congo has been torn by a military conflict. A particular atrocity of the war is widespread sexual violence.</p> <p>Methods</p> <p>In this combined retrospective analysis and prospective survey, we sought to identify hospital facilities and resources available to treat victims of sexual violence in Goma, the capital city of the North Kivu province.</p> <p>Results</p> <p>Of twenty-three acute care hospitals registered in the area of Goma, four (17%) regularly cared for victims of sexual violence. One hospital had all resources always available to appropriately care for victims of sexual violence. From Jan 2009 until Oct 2010, 7,048 females sought medical care because of physical or psychological sequelae from sexual violence in the four hospitals of Goma. Only half of the hospitals had physicians specialized in gynaecology or gynaecological surgery available. Similarly, anaesthetists and psychiatrists/psychologists were available in two (50%) and one (25%) hospital, respectively. Post-discharge care facilities, material resources, such as surgical and anaesthesiological equipment and drugs, were inconsistently available in the hospitals caring for sexually abused females. At one selected hospital, acyclovir and/or antibiotics were administered to 1,202 sexually abused females (89.5%), whereas post-exposure HIV prophylaxis and surgery because of vesico-vaginal fistula was provided to only 75 (5.6%) and 121 (9%) patients, respectively.</p> <p>Conclusions</p> <p>This study provides data that only few hospitals in Goma care for victims of sexual violence. In addition, these hospitals suffer from a relevant shortage of human and material resources to provide adequate care for sexually abused females. Aside from establishment of adequate protection strategies, steps must be taken to increase the availability of trained health care professionals and resources to provide adequate care for victims of sexual violence in Goma and the North Kivu province.</p

High prevalence of syphilis among demobilized child soldiers in Eastern Congo: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Syphilis, a known major public health issue for soldiers during periods of conflict, is exacerbated in the Democratic Republic of Congo due to widespread sexual violence. However, there has been no previous study to determine the extent of this problem. Therefore, we determined the prevalence of syphilis among young demobilized soldiers.</p> <p>Methods</p> <p>Screening of syphilis using the rapid plasma reagin test and the <it>Treponema pallidum </it>hemagglutination assay was conducted in three transit sites of soldier reintegration in 2005. The Fisher Exact probability test was used to compare results.</p> <p>Results</p> <p>The prevalence of syphilis was found to be 3.4%, with almost equal distribution in respect to sex, location.</p> <p>Conclusion</p> <p>Syphilis continues to be highly prevalent in demobilized child soldiers in Eastern Congo. Syphilis screening tests are recommended.</p

War related sexual violence and it's medical and psychological consequences as seen in Kitgum, Northern Uganda: A cross-sectional study

BACKGROUND: Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cessation of war related sexual violence against civilians in conflict zones, Africa continues to see some of the worst cases of war related sexual violence including the mass sexual abuse of entire rural communities particularly in the Great Lakes region. In addition to calling for a complete halt to this abuse, there is a need for the systematic study of the reproductive, surgical and psychological effects of war related sexual violence in the African socio-cultural setting.This paper examines the specific long term health consequences of war related sexual violence among rural women living in two internally displaced person's camps in Kitgum district in war affected Northern Uganda who accessed the services of an Isis-Women's International Cross Cultural Exchange (Isis-WICCE) medical intervention. METHODS: The study employed a purposive cross-sectional study design where 813 respondents were subjected to a structured interview as part of a screening procedure for an emergency medical intervention to identify respondents who required psychological, gynaecological and surgical treatment. RESULTS: Over a quarter (28.6%) of the women (n = 573) reported having suffered at least one form of war related sexual violence. About three quarters of the respondents had 'at least one gynaecological complaint' (72.4%) and 'at least one surgical complaint' (75.6%), while 69.4% had significant psychological distress scores (scores greater than or equal to 6 on the WHO SRQ-20). The factors that were significantly associated with war related sexual violence were the age group of less than or equal to 44 years, being Catholic, having suffered other war related physical trauma, and having 'at least one gynaecological complaint'. The specific gynaecological complaints significantly associated with war related sexual violence were infertility, chronic lower abdominal pain, abnormal vaginal bleeding, and sexual dysfunction. In a multivariable analysis the age group of less than or equal to 44 years, being Catholic and having 'at least one gynaecological complaint' remained significantly associated with war related sexual violence. CONCLUSION: The results from this study demonstrate that war related sexual violence is independently associated with the later development of specific gynaecological complaints

Caesarean section and subsequent fertility in sub-Saharan Africa.

OBJECTIVE: To determine the impact of caesarean section on fertility among women in sub-Saharan Africa. DESIGN: Analysis of standardised cross-sectional surveys (Demographic and Health Surveys). SETTING: Twenty-two countries in sub-Saharan Africa, 1993-2003. SAMPLE: A total of 35 398 women of childbearing age (15-49 years). METHODS: Time to subsequent pregnancy was compared by mode of delivery using Cox proportional hazards regression models. MAIN OUTCOME MEASURES: Natural fertility rates subsequent to delivery by caesarean section compared with natural fertility rates subsequent to vaginal delivery. RESULTS: The natural fertility rate subsequent to delivery by caesarean section was 17% lower than the natural fertility rate subsequent to vaginal delivery (hazard ratio = 0.83, 95% CI 0.73-0.96, P or =3 versus <3 years between the index birth and the previous birth was associated with higher odds of caesarean section at the index birth (OR = 1.4, 95% CI 1.1-1.7, P= 0.005); among all women, the odds of desiring further children were lower among women who had previously delivered by caesarean section (OR = 0.67, 95% CI 0.54-0.84, P < 0.001). Caesarean section did not appear to increase the risk of a subsequent pregnancy ending in miscarriage, abortion or stillbirth. CONCLUSIONS: Among women in sub-Saharan Africa, caesarean section is associated with lower subsequent natural fertility. Although this reflects findings from developed countries, the roles of pathological and psychological factors may be quite different because a much higher proportion of caesarean sections in sub-Saharan Africa are emergency procedures for maternal indication

Career Intentions of Medical Students Trained in Six Sub-Saharan African Countries

Please help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected] vir Onderrig en Leer (SOL

Selenium deficiency and toxicity in the environment

Selenium (Se) is a naturally occurring metalloid element, which is essential to human and other animal health in trace amounts but is harmful in excess. Of all the elements, selenium has one of the narrowest ranges between dietary deficiency (40 gday1) and toxic levels (400gday1) (WHO, 1996), which makes it necessary to carefully control intakes by humans and other animals, hence, the importance of understanding the relationships between environmental exposure and health. Geology exerts a fundamental control on the concentrations of selenium in the soils on which we grow the crops and animals that form the human food chain. The selenium status of populations, animals, and crops varies markedly around the world as a result of different geological conditions. Because diet is the most important source of selenium in humans, understanding the biogeochemical controls on the distribution and mobility of environmental selenium is key to the assessment of selenium-related health risks. High selenium concentrations are associated with some phosphatic rocks, organic-rich black shales, coals, and sulfide mineralization, whereas most other rock types contain very low concentrations and selenium-deficient environments are far more widespread than seleniferous ones. However, health outcomes are not only dependent on the total selenium content of rocks and soils but also on the amount of selenium taken up into plants and animals—the bioavailable selenium. This chapter demonstrates that even soils containing adequate total amounts of selenium can still produce selenium-deficient crops if the selenium is not in a form ready for plant uptake