Women's experiences of and preferences for services after rape in South Africa: interview study.

OBJECTIVES: To describe aspects of delivery of health services after rape, including trade-offs, that would most influence choice of service, and to compare views of patients who had used such services with views of members of the community who may be future users or may have experienced barriers to service use. DESIGN: Discrete choice analysis of stated preferences with interviews. Attributes included travel time to the service, availability of HIV prophylaxis, number of returns to the hospital, medical examination, and counselling skills and attitude of the provider. SETTING: One rural and one urban site in South Africa. PARTICIPANTS: 319 women: 155 who had been raped and four carers recruited through health facilities and 160 comparable women recruited from the community. Of these, 156 were from an urban site and 163 from a rural site. MAIN OUTCOME MEASURES: Strength of preferences over a range of attributes through the estimation of a benefit function through random effects probit modelling. RESULTS: Factors such as the availability of prophylactic treatment for HIV infection and having a sensitive healthcare provider who could provide counselling are more important in women's decisions to seek care after rape than the travel time necessary to access those services. CONCLUSION: Our findings support the need for holistic rape services.

Methodological issues in the South African incomplete abortion study.

In 1994, a national hospital-based study was undertaken of cases of incomplete abortion presenting to public hospitals in South Africa. Data were collected for all women admitted to a random sample of hospitals with incomplete abortion during a two-week period. The WHO protocol for such studies was used as a basis for developing the methods to describe the epidemiology of incomplete abortion and hospital management of cases. Attempts were made to estimate the proportion of cases that might have been induced. This report focuses on methodological issues arising from the study that have implications for future research. The findings demonstrate that only a small proportion of the women acknowledged having had an induced abortion and that only a few of those who did showed evidence of interference with pregnancy. Clinical opinion of sepsis and the likelihood of induction were found to be highly unreliable. These findings considerably reduce the usefulness of the WHO-protocol method of estimating the likely origin of incomplete abortions. Results presented in terms of three partially overlapping descriptive categories are judged to better reflect the limitations of the data collected.

Management of incomplete abortions at South African public hospitals. National Incomplete Abortion Study Reference Group.

OBJECTIVE: The objective of this report was to review and describe the management of incomplete abortion by public sector hospitals. DESIGN: A descriptive study in which data were collected prospectively from routine hospital records on all women admitted with incomplete abortion to a stratified random sample of hospitals between 14 and 28 September 1994. SETTING: Public sector hospitals in South Africa. PATIENTS: Women with incomplete abortions. MAIN OUTCOME MEASURES: Length of hospital stay, details of medical management, details of surgical management, determinants of the above. MAIN RESULTS: Data were collected on 803 patients from the 56 participating hospitals. Of these, 767 (95.9%) were in hospital for 1 day or more, and 753 (95.3%) women underwent evacuation of the uterus. Sharp curettage was the method employed in 726 (96.9%) and general anaesthesia was used for 601 (68%) of the women requiring uterine evacuation. Antibiotics were prescribed for 396 (49.5%) and blood transfusions were administered to 125 (17%) women. Statistical analysis showed length of stay to be longer in small hospitals (under 500 beds) and when the medical condition was more severe. Antibiotic usage and blood transfusion were more common with increasing severity and a low haemoglobin level on admission. However, some inappropriate management was identified with regard to both. MAIN CONCLUSIONS: It is suggested that uncomplicated incomplete abortion can be more effectively and safely managed using the manual vacuum aspiration technique with sedation/analgesia as an outpatient procedure. Attention should be directed at the introduction of this management routine at all types of hospital and to the ensuring of appropriate management of women with complicated abortion.

Crisis in our schools: survey of sanitation facilities in schools in Bloomsbury health district.

OBJECTIVE: To survey sanitation facilities in schools in Bloomsbury health district. DESIGN: Postal questionnaire. SETTING: Inner London health district. PARTICIPANTS: School nurses. RESULTS: 16 of 17 school nurses responded (37 of 41 schools). Fifteen schools did not have the minimum number of toilets and hand basins established in the Education (School Premises) Regulations 1981. In two schools toilets were kept locked for most of the day. In 10 schools toilet paper was not always available, and three of five secondary schools did not have disposal units for sanitary towels in the girls' toilet areas. In 18 of the schools the toilets were not kept adequately clean. CONCLUSIONS: These conditions raise serious questions about environmental health, with the potential for the spread of infectious diseases, and undermine attempts to teach children basic hygiene. Health professionals have an important role in assessing health and safety standards in schools and ensuring that necessary improvements are made.