Musculoskeletal impairment of traumatic etiology in Rwanda: prevalence, causes, and service implications.

BACKGROUND: The present study examines demographics, causes, and diagnoses of traumatic musculoskeletal impairment (MSI) in Rwanda and identifies treatment barriers in order to describe the injury burden and inform service planning. METHODS: In all, 105 clusters were chosen by multistage stratified cluster random sampling with probability proportional to size. Eighty people from each cluster were identified for screening by a modified compact segment sampling method. A screening questionnaire was applied and suspected cases and 10% of suspected non-cases underwent standardized examination. A structured interview obtained a detailed history, and an algorithmic classification system allocated diagnosis. RESULTS: Of 8,368 enumerated subjects, 6,756 were screened. Of these, 111 were traumatic MSI cases, with 121 diagnoses, giving a prevalence of 1.64% (95% CI 1.35-1.98). Extrapolation to the Rwandan population estimates 68,716 traumatic MSI cases, mostly in people of working age. Most affected were hand/finger joints (23%), elbow (16%), shoulder region (9%), and knee joint (9%). Some 11% of impairments were severe, 47.7% were moderate, and 41.3% were mild. Most common diagnoses were fracture malunion (21.5%) and post-traumatic joint stiffness (20.7%). The number of treatments needed was 199, including physiotherapy (87.2%) and surgery (53.7%), but 43% (95% CI 34-53) received less treatment than required. Of those who were undertreated, 63% cited cost. CONCLUSIONS: In Rwanda the prevalence of traumatic MSI of 1.64%, mostly in people of working age, makes usual activities difficult or impossible and is therefore a significant national burden. The results of the present study identify the need for immediate surgical intervention and physiotherapy, with cost as a treatment barrier. This study may direct aid providers toward subsidizing access to orthopedic care and thus reduce the impact of traumatic MSI

Woman's contraceptive needs and preferences in the postpartum period: an Italian study

none4Abstract AIMS AND OBJECTIVES: To describe what puerperal women know about postpartum contraception and to identify their related needs and expectations. BACKGROUND: Puerperal women face the problem of beginning or resuming contraception, the choice of the right method of contraception and the right time to start it. This choice becomes particularly important in case they breastfeed since the contraceptive method should not interfere with breastfeeding. Different factors, such as the level of knowledge women have about various contraceptive methods, their individual preferences or their desire to have a baby, can strongly influence this choice. DESIGN: A cross-sectional study had been carried out within the period of six months, from November 2011-February 2012. METHODS: Three hundred puerperal women were interviewed before their discharge from a Maternity Home. The women were asked for their personal characteristics, their maternity history, the information they had received, their knowledge and expectations about postpartum contraception and their intention to use contraception. RESULTS: During pregnancy and postpartum, 45.5% of the women reported that they had received adequate information about contraception. Of these ones, 64.3% reported their intention to use contraception either to avoid pregnancy or to space out future births, even if they did not always have appropriate knowledge about fertility and the use of contraceptive methods during postpartum. During this study, we also discovered that women's intention to use contraception was proportional to their level of education. CONCLUSION: Women need more and appropriate information about postpartum contraception, to make a conscious choice in relation to their needs and without putting their health at risk. RELEVANCE TO CLINICAL PRACTICE: To promote awareness of the choices related to postpartum contraception, it is important to understand the personal characteristics that influence or hinder this choice. Midwives can play a very important role in informing women and in developing educational interventions to support a safe contraceptive choice. © 2013 John Wiley & Sons Ltd. KEYWORDS: midwife, needs, postpartum contraception, preferences, reproductive health, womenPatrizia Di Giacomo;Alessia Sbarlati;Annamaria Bagnasco;Loredana SassoPatrizia Di, Giacomo; Alessia, Sbarlati; Bagnasco, Annamaria; Sasso, Loredan