Psychosocial implications of tubal ligation in a rural health district: A phenomenological study

<p>Abstract</p> <p>Background</p> <p>Tubal ligation is the most popular family planning method worldwide. While its benefits, such as effectiveness in protecting against pregnancies, minimal need for long-term follow-up and low side-effects profile are well documented, it has many reported complications. However, to date, these complications have not been described by residents in Congo. Therefore, the study aimed at exploring the experience of women who had undergone tubal ligation, focusing on perceptions of physical, psychological and contextual experiences of participants.</p> <p>Methods</p> <p>This qualitative study used a semi-structured questionnaire in a phenomenological paradigm to collect data. Fifteen participants were purposefully selected among sterilized women who had a ligation procedure performed, were aged between 30 and 40 years, and were living within the catchment area of the district hospital. Data were collected by two registered nurses, tape-recorded, and transcribed verbatim. Reading and re-reading cut and paste techniques, and integration were used to establish codes, categories, themes, and description.</p> <p>Results</p> <p>Diverse and sometimes opposite changes in somatic symptoms, psychological symptoms, productivity, ecological relationships, doctor-client relationships, ethical issues, and change of life style were the major problem domains.</p> <p>Conclusions</p> <p>Clients reported conflicting experiences in several areas of their lives after tubal sterilization. Management, including awareness of the particular features of the client, is needed to decrease the likelihood of psychosocial morbidity and/or to select clients in need of sterilization.</p

Mchinji District Health

Background: High mortality and disability due to pneumonia occur worldwide. The introduction of the Integrated Management of Childhood Illness strategy in Malawi brought with it hope of an improvement in the outcome of pneumonia. However, the risk of death and treatment outcomes remain unknown in many districts. A f fi l i a t i o n s:

Morbidity profile in a rural community-based rehabilitation programme in Butembo, North Kivu Province, Congo

Background: Medicine in low socio-economic countries is primarily disease-oriented; prevention and rehabilitative care are secondary concerns. Hence, curative care erodes the few resources allocated to health. Despite the well-documented benefits of communityrehabilitation in the management of chronic conditions, little is known about common conditions present in the community in Butembo. Objectives: The objective of this study was to determine the conditions encountered during rehabilitation in Butembo and to identify the trends of the five most common conditions during the study period. Method: Data were extracted from a rehabilitation programme connect to one centre in Butembo. A descriptive retrospective medical study was performed for the period between 2004 and 2007. Descriptive statistics with percentages were computed. The Chi-square test was used to evaluate the differences with a probability of 5%. Results: Cerebral palsy (46.9%), cataract (17.3%), clubfoot (11.8%), glaucoma (6.8%), and cleft lip (4.5%) were the most commonly encountered conditions, with cerebral palsy the most common condition throughout the study period. With regard to gender, male patients were significantly more affected by cataracts (p = 0.0290), clubfoot (p < 0.0100) and glaucoma (p < 0.0100) than female patients. Children aged five or younger had a higher incidence of cerebral palsy (χ2 = 263.2, df = 1, p = 0.0000) cataract (p = 0.0170), clubfoot (p < 0.0010), and glaucoma (p = 0.0010). Additionally, the overall comparisons by gender and age demonstrated differences for the five most common conditions (χ2 = 15.3, df = 4, and p = 0.0040; and χ2 = 114, df = 4, and p < 0.0001 for gender and age, respectively). Conclusion: Common conditions and associated factors were identified that will add to the effectiveness of the programme in terms of materials needed, staff skills, and programming. Special skills are still needed to help treat some acute conditions that can be handled at the rehabilitation centre, and a triage of attending rehabilitation centres could improve the effectiveness of the programme and lower the possibility of missed opportunities for acute stage patients

Pneumonia in rural Malawians under five years old: Treatment outcomes and clinical predictors of death on admission

Background: High mortality and disability due to pneumonia occur worldwide. The introduction of the Integrated Management of Childhood Illness strategy in Malawi brought with it hope of an improvement in the outcome of pneumonia. However, the risk of death and treatment outcomes remain unknown in many districts. Method: The medical records of 466 consecutive patients admitted to the Mchinji District Hospital from January 2004 to January 2006 whose disease met the World Health Organization criteria for pneumonia were reviewed. Data were collected from forms that had been filled out and different treatment outcomes and determinants of death were analysed using logistic regression. Results: Of the 466 patients, 62.7% completed treatment, 15.9% had unknown outcomes, 12.9% died, 8.4% were lost to follow-up, 0.8% failed to improve with treatment, and 0.4% were transferred to other facilities. Independent predictors of death were: age less than 2 years, female sex, history of pneumonia, chest retractions, type of pneumonia, and central cyanosis. Conclusion: A high proportion of deaths and unknown outcomes occurred among participants. Young age, female sex, history of pneumonia, chest retractions and central cyanosis were associated with death. Mortality from pneumonia may be reduced by close monitoring of these risk factors and by improving health education programmes and communicating these findings to parents and health workers. Further investigations of local reasons for high rates of unknown/unreported outcomes are welcomed

Health care seeking and financial behaviours of the elderly during wartime in Goma, Democratic Republic of Congo

Background: Health and social services utilisation is seen to be more closely related to age than to other socio-demographic characteristics. Many health problems are known to increase with age and this demographic trend may lead to an increase in the absolute number of health conditions in this population. However, questions are still emerging as to how the elderly seek care in response to their needs in the context of a war-torn region. Objectives: The aim of this study was to determine the behaviour of the elderly in seeking care during a time of conflict. Method: A descriptive cross-sectional study was carried out in the health district Goma, in the Democratic Republic of the Congo (DRC), using a multistage sampling of 500 senior citizens. Eight trained field-workers were deployed in the field where they administered a structured questionnaire. Results: The public health sector was well known and preferred by 186 participants (37.2%), but only used by 16 (3.2%) participants. Financial support received by the elderly came from their own relatives and fellow believers in 33.5% and 20.2% of cases, respectively. Almost 71% of monetary support is the result of begging and unknown sources – there is no government involvement whatsoever. Much of the external support that the elderly receive involves support in the form of food. Disease expenses remain a main concern of the elderly themselves. Conclusion: Government support for the elderly in the DRC is non-existent. There is an overuse of private sector and traditional medicine, despite the preference indicated for the public health sector. As a recommendation, a general increase in income-related activities could contribute to alleviating the health state of the elderly in a war situation. Further studies might explore in future the contribution of those results on the health of elders