Subject(s)
Ambulatory Care , Respiratory Tract Diseases , Adolescent , Child , Humans , Infant , Respiratory Tract Diseases/therapySubject(s)
Lung Diseases , Oxygen Inhalation Therapy , Adult , Humans , Lung Diseases/therapy , Practice Guidelines as TopicSubject(s)
Smoking Cessation , Tobacco Products , Tobacco Use Disorder , Adult , Humans , Nicotiana , Tobacco Use Disorder/drug therapySubject(s)
Antitubercular Agents/administration & dosage , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Drug Administration Schedule , Drug Therapy, Combination , Humans , Tuberculosis, Multidrug-Resistant/microbiology , Tuberculosis, Pulmonary/microbiologyABSTRACT
BACKGROUND: Treatment and care for female genital fistula have become increasingly available over the last decade in countries across Africa and South Asia. Before the International Federation of Gynaecology and Obstetrics (FIGO) and partners published a global fistula training manual in 2011 there was no internationally recognized, standardized training curriculum, including perioperative care. The community of fistula care practitioners and advocates lacks data about the prevalence of various perioperative clinical procedures and practices and their potential programmatic implications are lacking. METHODS: Data presented here are from a prospective cohort study conducted between September 2007 and September 2010 at 11 fistula repair facilities supported by Fistula Care in five countries. Clinical procedures and practices used in the routine perioperative management of over 1300 women are described. RESULTS: More than two dozen clinical procedures and practices were tabulated. Some of them were commonly used at all sites (e.g., vaginal route of repair, 95.3% of cases); others were rare (e.g., flaps/grafts, 3.4%) or varied widely depending on site (e.g. for women with urinary fistula, the inter-quartile range for median duration of post-repair bladder catheterization was 14 to 29 days). CONCLUSIONS: These findings show a wide range of clinical procedures and practices with different program implications for safety, efficacy, and cost-effectiveness. The variability indicates the need for further research so as to strengthen the evidence base for fistula treatment in developing countries.
Subject(s)
Gynecologic Surgical Procedures/methods , Perioperative Care/methods , Rectovaginal Fistula/surgery , Urethral Diseases/surgery , Urologic Surgical Procedures/methods , Vesicovaginal Fistula/surgery , Adult , Anesthesia, Spinal , Anti-Bacterial Agents/therapeutic use , Bed Rest , Drinking , Enema , Family Planning Services , Female , Humans , Operative Time , Physical Examination/methods , Prospective Studies , Recovery of Function , Treatment Outcome , Urinary Bladder/physiology , Urinary Catheterization , Young AdultABSTRACT
OBJECTIVE: We compared 12-month continuation rates, menstrual bleeding patterns and other aspects of acceptability between users of Cyclofem and users of Depo-Provera. METHODS: The life-table method was used to calculate quarterly continuation rates. In all, 360 Kenyan women were randomly assigned to one of the two contraceptives. User-satisfaction questionnaires were administered at 6 and 12 months or at discontinuation, whichever occurred first. RESULTS: The 1-year continuation rate was 75.4% for Depo-Provera users versus 56.5% for Cyclofem users (p<.001). Main reasons for discontinuation included difficulty making clinic visits (45.1% for Cyclofem vs. 40% for Depo-Provera), menstrual changes (14.1% vs. 12.5%) and nonmenstrual problems (15.5% vs. 12.5%). None of the Depo-Provera users and 8.5% of the Cyclofem users claimed frequency of visits as the main reason for discontinuation. In all, 70.6% of the Depo-Provera users were amenorrheic after 12 months, as were 20.8% of the Cyclofem users. CONCLUSIONS: The 1-year continuation rate was higher for Depo-Provera than for Cyclofem. There was no important difference in discontinuation rates because of menstrual problems; the difference mainly reflected the frequency of visits required.