Improving the quality of care for female rape survivors at Scottish Livingstone Hospital, Molepolole, Botswana: a quality improvement cycle

Background: Rape is prevalent in Botswana, but there has been limited research undertaken to improve the quality of healthcare for female rape survivors in this clinical setting. Research can not only influence the health outcomes of victims but also has the potential to inform policy. Aim: The aim of this study was to improve the quality of care for female rape survivors in Scottish Livingstone Hospital, Molepolole, Botswana. Setting: The setting is Scottish Livingstone Hospital, Molepolole, Botswana. Methods: This study was a qualitative cycle, using the normal steps of performing a baseline audit of clinical practice, planning and implementing changes and re-audit. Results: A total of 124 patient records were audited, comprising 62 patient records at baseline and re-audit. The mean age of victims was 23 years and the age category with the highest incidence of rape ranged between 12 and 20 years, constituting 47% of patients' records. During the baseline audit, only one out of 10 structural standards was met, while at re-audit eight structural standards were fully met. Although none of the process standards were met during both audits, statistically significant improvements in performance (p < 0.05) were shown in six out of 10 criteria at re-audit. Conclusion: The quality of care for female rape survivors is suboptimal in our setting. However, simple interventions to improve the structure in place for patients and upskilling the entire practice team to align care to current international standards can improve the overall quality of healthcare

Gendered childcare norms ­ evidence from rural Swaziland to inform innovative structural HIV prevention approaches for young women

Addressing discriminatory gender norms is a prerequisite for preventing HIV in women, including young women. However, the gendered expectation that women will perform unpaid childcare-related labour is rarely conceptualised as influencing their HIV risk. Our aim was to learn from members of a rural Swazi community about how gendered childcare norms. We performed sequential, interpretive analysis of focus group discussion and demographic survey data, generated through participatory action research. The results showed that gendered childcare norms were firmly entrenched and intertwined with discriminatory norms regarding sexual behaviour. Participants perceived that caring for children constrained young women's educational opportunities and providing for children's material needs increased their economic requirements. Some young women were perceived to engage in "transactional sex" and depend financially on men, including "sugar daddies", to provide basic necessities like food for the children they cared for. Our results suggested that men were no longer fulfilling their traditional role of caring for children's material needs, despite women's traditional role of caring for their physical and emotional needs remaining firmly entrenched. The results indicate that innovative approaches to prevent HIV in young women should incorporate structural approaches that aim to transform gendered norms, economically empower women and implement policies guaranteeing women equal rights

Women's Education; Empowerment; and Contraceptive Use in sub-Saharan Africa: Findings from Recent Demographic and Health Surveys

Fertility remains higher and contraceptive levels are substantially lower in Sub-Saharan Africa than elsewhere in the developing world. In this paper we use information on individuals and couples provided in recent Demographic and Health Surveys (DHS; fifth wave) undertaken in Ghana; Kenya; Madagascar; and Zambia. We use bivariate and multivariate techniques to examine the determinants of contraceptive use among married women (aged 15-49); focusing on the impacts of women's education and empowerment. Our results show that education was an important determinant of contraceptive use; but mattered less in choice of method effectiveness. The impact of education was similar in all the countries studied with the exception of Kenya; where it was non-existent. Empowerment was less important in determining contraceptive use. Efforts to increase contraceptive use in general and the use of modern methods more specifically need to focus on providing basic education for all women and on changing gender roles

Prevention of Sexual Assault in Nigeria

Sexual assault occurs commonly worldwide and is particularly pervasive in the developing world. The background to sexual violence is important in the understanding of the ramifications of the problem. Some elements that offer the means to the prevention of sexual assault in the community are important highlights especially where the means - expertise and facilities - for managing cases of sexual assault is grossly inadequate. These concepts; though are applicable universally; are however discussed in the context of the developing world and with particular emphasis on the Nigerian situation. Their applicability in sexual assault prevention is derived from previous studies in different parts of the world that highlight the viability of these interventions. Therefore if one posits that sexual assault can be prevented; certain responsibilities are imperative; some challenges must be anticipated; and special needs/circumstances should be catered for

Discovery of, and response to husbands' HIV positive status: the groaning voices of Vhavenda women

Many couples find themselves in situations that are difficult to understand when there is discordance concerning HIV infection. This situation warrants a lot of questions that do not have answers and for many people it leaves them with ambivalent feelings towards the spouse. The present study was conducted to explore the emotions that women experience when the husband tests HIV positive. Semi-structured interviews were conducted with six (age range: 36 to 42 years; mean age: 38.0 years; ethnicity: Venda; marital status: married) purposively selected women who consulted for psychological intervention needed to care for their sick husbands. Data were analysed using thematic content analysis. The results of this study indicated that the women went through different emotions and they had reacted differently to the news depending on other circumstances in their marriage. It is therefore recommended that support groups for these women be established to offer them an opportunity to share their experiences and feelings

Rural women's understanding of the concept of menopause in Limpopo Province, South Africa

The word 'menopause' is derived from men and pausis and is a direct description of the psychological and physical events in women where menstruation ceases to occur. It is the time in a woman's life when she has experienced the last menstrual bleed. Menopause is not a disease per se but a condition associated with hormonal changes where estrogen diminishes to a low level causing health related symptoms. The purpose of this study was to explore and describe the knowledge of rural women concerning menopause in Mutale Municipality; South Africa. A qualitative; explorative; descriptive and contextual design was used. Purposive sampling was used to select the four villages and the focus groups. Sample size was determined by data saturation. The findings of the study indicated that the rural women in Mutale community had the common traditional understanding of the concept menopause; that blood is gone; old age; it was God' nature of doing things and that cessation of menstruation was a normal and natural transition. They could not attach cessation of menstruation to menopausal conditions but to old age and physical as well as psychological health related problems. There is need for health care providers to conduct workshops in order to enlighten rural women in this community regarding phenomenal issues of menopause

Violences conjugales a Antananarivo (Madagascar): un enjeu de sante publique

Introduction: La violence conjugale a ete etudiee dans beaucoup de pays developpes mais peu en Afrique subsaharienne. Madagascar est unpays ou ce phenomene est peu documente. Methodes: En 2007; une enquete sur la violence conjugale a Antananarivo (ELVICA) a ete menee surla violence conjugale envers les femmes dans la capitale malgache. ELVICA a interroge 400 femmes en union; de 15 a 59 ans. Des informationssur les caracteristiques demographiques; socioeconomiques des couples ont ete collectees ainsi que sur les actes de violences physiques deshommes sur leurs epouses. L'objectif de cet article est d'identifier les facteurs de risques de la violence conjugale grave; celle qui a desconsequences sur la sante physique des femmes. Resultats: Trente-cinq pour cent des femmes qui ont declare avoir subi au moins une forme deviolence physique au cours des 12 mois precedent l'enquete. Presque la moitie (46) des femmes violentees ont declare avoir deja eu deshematomes; et environ un quart (23) des plaies avec saignement. Vingt-deux pour cent ont deja du consulter un medecin. Parmi les nombreusesvariables socioeconomiques et demogra-phiques testees; quelques-unes sont associees positivement au risque de violence conjugale grave: le faitpour une femme d'etre en union consensuelle et d'avoir une activite professionnelle. Il y aussi un lien entre la violence subie et l'autonomie des femmes (liberte accordee par le mari de travailler; de circuler; de voir sa famille). Conclusion: A Madagascar; comme ailleurs; la lutte contre les violences conjugales est un element majeur de l'amelioration du statut et de la sante des femmes

Changes in Total and Differential white Cell Counts; Total Lymphocyte and CD4 Cell Counts during the Menstrual Cycle in Healthy Female Undergraduate Students in Port Harcourt; Nigeria

Background: Published reports on the possible changes in the various immune cell populations; especially the total lymphocyte and CD4 cell counts; during the menstrual cycle in Nigerian female subjects are relatively scarce. Aim: To determine possible changes in the total and differential white blood cell [WBC] counts; total lymphocyte count [TLC] and CD4 cell count during the menstrual cycle in apparently healthy reproductive aged female undergraduate students in Port Harcourt; Nigeria. Methods: A total of 61 apparently healthy HIV sero-negative female undergraduate students of the University of Port Harcourt; Nigeria aged between 17 and 30 years; were recruited into the study. Subjects were allowed their normal daily routines but restricted from excessive physical activities for the duration of the study. After a menstrual history; blood was collected from each subject at the different phases of the menstrual cycle: menstrual; follicular; ovulatory and luteal. Total WBC and differential counts were determined manually; TLC was obtained by multiplying the percentage lymphocytes by the total WBC count; CD4 cell counts were determined by flow cytometry. Results: Single factor analysis of variance showed significant differences only in the values of total WBC; and differential neutrophils; lymphocytes; and eosinophil counts [p0.05]; no significant differences were observed in the values of monocytes; basophils; TLC and CD4 cell count during the phases of the menstrual cycle.Conclusion: The present study confirms previous reports of significant physiological variations in the leukocyte counts during the phases of the normal menstrual cycle. However; our results suggest that apparently TLC and CD4 cell count do not undergo a similar physiological variation

Women's Health; HIV/AIDS and the Workplace in South Africa

This work explores the connections between gender inequality; HIV/AIDS and women's health in the world of work in South Africa. These connections are located within a context of significant reversals in development; specifically declining life expectancy and premature mortality for South Africans - particularly for women. By relying on the existing literature and interviews with 33 key informants; the paper examines the extent to which South African workplaces are recognising women's social and biological vulnerability to HIV. In particular; the paper considers the potential role of the workplace in responding to growing evidence that links gender and health by establishing targeted HIV/AIDS interventions. The findings suggest that the vast majority of company representatives do not recognise women's social and biological vulnerability and related social norms vis-a-vis HIV and AIDS. Importantly; most workplaces are not initiating programmes that specifically address women's or men's health. The author briefly identifies factors that may help explain the current state of knowledge and practice in the realm of HIV and women's health in the workplace; and puts forward suggestions for future research

Opinion of South African Pre- and Post-Menopausal Women on the Potential Menopause-Related Health Benefits of Soy and Soy products

The increased use of alternative treatment for menopausal symptoms is mainly due to women's changing opinions of conventional hormone replacement therapy (HRT). The objective of this study was to assess the opinion of preand post-menopausal South African women regarding the potential menopause-related health benefits of soy. The sample used for the study was a sub-dataset of 825 respondents; which included only pre- and post-menopausal women that had heard of soy before; selected from a representative sample of the adult South African metropolitan and rural populations. A structured questionnaire was used. Neither age nor racial groups differed practically significantly in opinion regarding any of the various statements. The study also shows that a practically significant lower proportion of women in the sub-population across both age and race groups had a positive opinion on the health benefits of soy as an alternative to HRT and reliever of menopausal symptoms than those who acknowledged its benefit for preventing cardiovascular disease and osteoporosis. Practically significantly more women who used soy than women who never used soy agreed that soy keeps bones strong. In addition; more women who were of opinion that soy has few or no health benefits disagreed that soy could be used as an alternative to HRT compared to women who held a positive opinion

Antimicrobial Susceptibility of Community-associated Staphylococcus aureus Isolates from Healthy Women in Zaria; Nigeria

Purpose: An investigation of the antimicrobial susceptibility patterns of Staphylococcus aureus isolated from healthy women to ten commonly used antimicrobial drugs was carried out as a basis for a guide for empirical antimicrobial treatment using urine samples. Method: The samples collected from healthy women volunteers in Zaria were cultured and screened for S. aureus using standard microbiological procedures. The antimicrobial susceptibility of the isolates was investigated using disc diffusion technique. Result: A total of 54(36) S. aureus isolates were isolated from 150 urine samples collected. Of the 54 isolates; 16 (29.6); 15 (27.8) and 23 (42.6) were from married but not pregnant; pregnant and single women respectively. The isolates were highly susceptible to ciprofloxacin; gentamicin; ofloxacin; sparfloxacin and pefloxacin in both groups (married and single). The differences observed in all the antimicrobial drugs tested for both groups were not statistically significant (p0.05). A total of 34 (63) of the isolates showed multi-drug resistance and only 6 (11) were susceptible to all the antimicrobial drugs tested. Conclusion: This observation calls for measures to reduce the reservoir of antimicrobial resistant organisms in healthy populations

HIV/AIDS in Cameroon: Rising Gender Issues in Policy-Making Matters

This literature review investigated gender differentials in HIV/AIDS in Cameroon and to which extent gender was taken into account in the country's current policy on HIV/AIDS. The review found that in Cameroon women were at increased risk of being infected with HIV/AIDS compared to men and that apart from biological vulnerability; socio-cultural as well as economic factors accounted for those differences. In addition; the review found that at the policy level; the government has drawn up plans to reduce the high prevalence of HIV/AIDS among women. However; although the current policy acknowledged the need for tackling gender differentials in HIV/AIDS transmission; little has been done at the level of implementation. The current policy needs to be implemented in a more effective manner and a multisectorial approach should be explored in order to curb the current trend of the feminization of HIV/AIDS in Cameroon

Bilan d'activite annuel de l'echographie en strategie avancee dans la region de Ziguinchor (Senegal)

Pour renforcer l'accessibilite de l'echographie aux populations rurales; un programme d'echographie en strategie avancee a ete institue dans les districts sanitaires de Sedhiou; Oussouye; Bignona et Ziguinchor; en Casamance; au Senegal. Durant l'annee 2001; 56 sorties ont ete effectuees au benefice de 1273 patientes. Les principales indications etaient le bilan de grossesse; l'amenorrhee; le desir de grossesse; la douleur; lesmasses pelviennes; et les hemorragies. Les resultats etaient pathologiques dans 25des cas. Les pathologies etaient gravidiques dans 47des cas; et gynecologiques dans 53. La conduite a tenir etait un rendez-vous de controle dans 15des cas; un traitement dans 24; et une reference vers le centre hospitalier regional dans 61. La strategie avancee a donc ete profitable aussi bien au niveau des structures de sante qu'au niveau communautaire dans la prise en charge des problemes de sante. D'ou l'interet de sa promotion en attendant l'equipement des hopitaux de district en appareils d'echographie; et la formation de leur personnel a la pratique de l'echographie

Compliance of young children with ITN protection in rural Burkina Faso

Background Insecticide-treated bed nets (ITNs) are known to be highly effective in reducing malaria morbidity and mortality. The effectiveness of ITNs is largely influenced by behavioural factors. However; not much is known regarding such factors under programme conditions. Methods This descriptive study was nested into a large ITN effectiveness study in rural Burkina Faso. In the course of two cross-sectional surveys during the dry and the rainy season of 2003; random samples of young children from nine representative villages (n=180 per survey) were investigated for compliance with ITN protection and related behaviour. Data were collected through direct observations and through interviews with mothers. Results ITNs were perceived as very important for protection against mosquitoes and malaria particularly during the rainy season; but there were problems with their use during the dry season. Young children usually slept with their mother under the ITN and self-reported compliance was 66and 98during dry and rainy seasons respectively (confirmed by direct observation in 34and 79respectively). Important reasons for low compliance during the dry season were high temperatures inside houses and problems related to changing sleeping places during the night. conclusions Under programme conditions; compliance with ITN protection in young children is sufficient during the rainy season; but is rather low during the hot and dry season. Greater emphasis needs to be placed on information/education efforts to make people aware of the fact that the risk of contracting malaria may persist throughout the year

Dysmenorrhoea

Dysmenorrhoea is the leading cause of recurrent short-term school absence in adolescent girls and a common problem in women of reproductive age. Risk factors for dysmenorrhoea include nulliparity; heavy menstrual flow; smoking; and depression. Empiric therapy can be initiated based on a typical history of painful menses and a negative physical examination. Non-steroidal anti-inflammatory drugs are the initial therapy of choice in patients with presumptive primary dysmenorrhoea. Oral contraceptives and depo-medroxyprogesterone acetate also may be considered. If pain relief is insufficient; prolonged-cycle oral contraceptives or intravaginal use of oral contraceptive pills can be considered. In women who do not desire hormonal contraception; there is some evidence of benefit with the use of topical heat; the Japanese herbal remedy toki-shakuyaku-san; thiamine; vitamin E; and fish oil supplements; a low-fat vegetarian diet; and acupressure. If dysmenorrhoea remains uncontrolled with any of these approaches; pelvic ultrasonography should be performed and referral for laparoscopy should be considered to rule outsecondary causes of dysmenorrhea. In patients with severe refractory primary dysmenorrhoea; additional safe alternatives for women who want to conceive include transcutaneous electric nerve stimulation; acupuncture; nifedipine; and terbutaline. Otherwise; the use of danazol or leuprolide may be considered and; rarely; hysterectomy. The effectiveness of surgical interruption of the pelvic nerve pathways has not been established

ABO phenotypes and malaria related outcomes in mothers and babies in The Gambia: a role for histo-blood groups in placental malaria?

Background This study analyses the association between ABO blood group phenotypes in relation to placental malaria pathology. Methods A total of 198 mother/child pairs delivering in Banjul and the Kombo-St Mary District (The Gambia) were analysed. ABO blood group was measured by agglutination. Placental malaria parasites were enumerated and the presence of malaria pigment noted. Birth anthropometry was recorded and placental weight. Maternal and infant haemoglobin was measured. Results 89 (45) subjects were primiparae and 110 (55) multiparae. The ABO phenotype distribution was 38(A); 52(B); 6(AB) and 102(O). Placental histo-pathology showed active placental malaria in 74 (37); past infection in 42 (21) and no infection in 82 cases (41). In primiparae; blood group O was associated with a higher risk of active infection (OR= 2.99; 95CI= 1.24-7.25); and a lower risk of past infection (OR = 0.31; 0.10-1.01; p0.05). In multiparae; the O phenotype was associated with reduced prevalence of active or past placental infection (OR