Prevalence and factors associated with genital prolapse: a hospital-based study in Alexandria [Part I]

Most hospital-based studies on genital prolapse focus on the contribution of prolapse to the overall hospital incidence rate of hysterectomy. The present study targeted the outpatient clinic of a teaching and reference hospital [The Maternity University Hospital in Alexandria] to determine the prevalence and possible factors associated with genital prolapse among the attendants of the gynecological outpatient clinic. Through a cross sectional approach, a systematic random sample of 400 women [being non-pregnant age 25 years and over], was selected from the outpatient clinic over a period of 6 months. They were subjected to: 1] a structured interview using a questionnaire, 2] clinical examination, and 3] measurement of body mass index [BMI]. Pelvic examination revealed a high prevalence rate, moderate and large degrees were present in 40% of them. Cysto-rectocele was the commonest type [65.5% of the whole sample], followed by utero-vaginal prolapse [3.5%]. The most commonly reported complaints [89.9%] were not related to genital prolapse. Symptoms specific to prolapse were reported on inquiry by a small proportion of cases [25.8%]. Comparing women's report and diagnoses indicated a low sensitivity [33%] and very high specificity [100%]. Stress incontinence and multiple sexual consequences were the most frequently reported complications [60.1% and 66.7% respectively]. Stepwise logistic regression analysis revealed that five variables only were significant predictors of prolapse: parity 3+ [p= .0001, C1= 1.67-5.25], unskilled birth attendant [p= .0006, C1= 1.2-3.2], prolonged labor [p= .007, C1= 1.7-7.6], early resumption of routine activities during puerperium [p= 002, C1=1.7-11.3] and history of obvious weight loss [p=0026, C1= 1.19-17.2]. The presence of many silent cases of prolapse among outpatients in spite of having moderate and severe degrees indicates that health education on different aspects of reproduction is highly required to encourage women to know and report their sufferings. Improving the skills of birth attendants, focussing on domiciliary obstetrics is also emphasized

Use of breast feeding indicators for assessment of current feeding practices

To investigate the current breast feeding practices, a survey was conducted cross sectionally on 2000 children aged less than 2 years recruited from 6 MCH centers in Alexandria governorate. The median duration of breast feeding was 19.4 months. Only one quarter of infants were exclusively breast fed for the first four months of age with a mean duration of 2.4+2.5 months. Predominantly breast feeding rate was 0.36, while timely complementary breast rig rate [6-9 months] was 0.66. Continued breast feeding rate [one year] was 0.73 while for two years was 0.3. Results also indicated that 40% of infants were receiving food from a bottle with a nipple/teat regardless of whether or not the infant was breast fed. These findings implicate that promotion of breast feeding should receive priority in health programs activities

Impact of an in-service training program on physicians' knowledge and skills of growth monitoring

A training program was implemented on a sample representing about 25% of physicians [n = 60]. A post-test only control group design was used. Physicians were randomly assigned into an experimental [n = 30] and a control group [n = 30]. Physicians of the experimental group attended a classroom-based course on the theoretical aspects of growth monitoring and a field-based training on the techniques of measuring weight and height. A questionnaire of 12 points was used for testing their knowledge and two observation checklists for assessing their performance after the training. Physicians of the experimental group scored significantly higher in knowledge [9.27/12] than those of the control group [7.45/12]. The improvement was more evident in interpretation than in plotting abilities. Assessment of their skills of measuring revealed marked variability in correct responses to the various tasks within and between groups. However, the experimental group showed significantly higher level of performance than the control group in weight [60% vs. 6.7%] and height [73.3% vs. 30%, P <0.01] measurements. The impact of training was quite satisfactory. Conducting regular GM sessions is recommended till the adoption of a national GM program