Hysterectomy: still a treatment of choice for pelvic pathologies in rural India

Background: Hysterectomy has always been a subject of controversy in India and increasing rate of unnecessary hysterectomies in young, premenopausal women is cause for concern regarding women’s health and rights. The aim of this study is to review and analyse cases of hysterectomy in a rural population and to correlate with underlying factors behind seeking hysterectomy as a treatment of choice for pelvic pathologies.Methods: This was an ambidirectional observational descriptive study in which 352 women were included who underwent hysterectomy between January 2016 to July 2017 in the Department of Obstetrics and Gynecology, Government Medical College Rajnandgaon and a tertiary care referral hospital of central Chhattisgarh, India.Results: Majority were between 31-50 years of age group, grandmultipara, uneducated, insured by National health insurance scheme.76.1% patients had attended medical college hospital to avail free services. 60.5% took prior treatment from unqualified/ unregistered/registered general practitioners. Erratic use /use of suboptimal dosage of hormones to stop abnormal uterine bleeding, nonspecific antibiotics to treat infection, incomplete treatment and poor compliance were possible reasons behind failure of previous treatments. Abnormal menstruation was the commonest presenting complaint observed in 75.2%. 72.4% patients refused to come for follow up and reasons were unavailability of transport facility, fear of losing job, loss of daily wages and financial constraints. Commonest indication for hysterectomy was symptomatic fibroid in 32.0%. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was the most common procedure done in 59.0%. The rate of hysterectomy came out to be 57.6% which is quite higher than that reported in other studies. Fever was the most common complication encountered in 0.80%.Conclusions: Despite the remarkable improvement in conservative management and media coverage, hysterectomy still remains the most preferred modality of treatment with excellent satisfaction for pelvic pathologies in rural India

Awareness and practices of cervical cancer screening among women in Rajnandgaon district, central India: health education is the need of the hour

Background: Cervical cancer is a leading cause of morbidity and mortality among rural women in India. Early screening has been shown to be the most effective measure to prevent the disease. However, lack of awareness, lack of infrastructure, social stigma and fear are barriers to cervical cancer screening. The study was undertaken to assess the knowledge and practice among rural women regarding cervical cancer and screening tests with the aim of helping health professionals to revise policies and practices.Methods: It was a cross-sectional questionnaire-based study, conducted from January 2018 to September 2018 in the Department of Obstetrics and Gynecology at Government Medical College Rajnandgaon. A tertiary care hospital located in the southwest Chhattisgarh. A total of 506 women aged 21-65 years were included and assessed. Qualitative data were presented as frequencies and percentages by using SPSS version 21.Results: Of the total 506 respondents, 15.41 % had heard of cervical cancer, while 8.1% about cervical cancer screening. Unfortunately, only 1.2% women were ever been screened by Pap test. Although importance of screening had been thoroughly explained to the respondents, despite the fact only 57.1% showed willingness to undergo cervical cancer screening in the future. However, 63.9%women having gynecological complains were significantly associated with better attitude towards future cervical cancer screening than women without having gynaecological complains.Conclusions: Awareness and practice of the screening for cervical cancer was very poor in the rural population as well as in health care providers. Hence intensive health education is the need of the hour to change the scenario

Hysterectomy: still a treatment of choice for pelvic pathologies in rural India

Background: Hysterectomy has always been a subject of controversy in India and increasing rate of unnecessary hysterectomies in young, premenopausal women is cause for concern regarding women’s health and rights. The aim of this study is to review and analyse cases of hysterectomy in a rural population and to correlate with underlying factors behind seeking hysterectomy as a treatment of choice for pelvic pathologies.Methods: This was an ambidirectional observational descriptive study in which 352 women were included who underwent hysterectomy between January 2016 to July 2017 in the Department of Obstetrics and Gynecology, Government Medical College Rajnandgaon and a tertiary care referral hospital of central Chhattisgarh, India.Results: Majority were between 31-50 years of age group, grandmultipara, uneducated, insured by National health insurance scheme.76.1% patients had attended medical college hospital to avail free services. 60.5% took prior treatment from unqualified/ unregistered/registered general practitioners. Erratic use /use of suboptimal dosage of hormones to stop abnormal uterine bleeding, nonspecific antibiotics to treat infection, incomplete treatment and poor compliance were possible reasons behind failure of previous treatments. Abnormal menstruation was the commonest presenting complaint observed in 75.2%. 72.4% patients refused to come for follow up and reasons were unavailability of transport facility, fear of losing job, loss of daily wages and financial constraints. Commonest indication for hysterectomy was symptomatic fibroid in 32.0%. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was the most common procedure done in 59.0%. The rate of hysterectomy came out to be 57.6% which is quite higher than that reported in other studies. Fever was the most common complication encountered in 0.80%.Conclusions: Despite the remarkable improvement in conservative management and media coverage, hysterectomy still remains the most preferred modality of treatment with excellent satisfaction for pelvic pathologies in rural India