Quality of family planning service in Dembia district, north west Ethiopia

OBJECTIVE: Ethiopia is one of the countries with high population and population growth rate. Providing quality family planning service is the major strategy to control the population growth. Since there were no studies conducted in Northwest Ethiopia regarding quality of family planning services, this study was conducted with the objective of assessing the quality of family planning services in Dembia district, Northwest Ethiopia. MATERIALS AND METHODS: A cross sectional community and health institution based study was conducted in April 2004. One hundred sixty five women were included in the household survey. For the assessment of availability of different family planning methods, technical competence of service providers, and appropriate constellation of services, the District Health (Office, one health center, three health stations, and 8 Community Based Reproductive Health Agents were selected. RESULTS: The maximum number of available methods in the sites was 3. All the 165 clients were informed how and when the method should be used but the information provided regarding the side effects of the methods was insufficient. In all the service delivery points there were 9 (40.9%) service providers who got additional training on family planning. Except one health officer, there was no one who can insert IUCD. All the five health professionals in the health center and 2 (28.6%) health professionals in the three health stations can inject depo provera. One hundred and six (64.2%), and 50 (30.3%) of the clients rated the providers relation with the clients as very good and good, respectively. All the clients had follow up appointments. One hundred forty two (86.1%) of the current users have used the method for one year and over. The working days for all government health institutions in the district are from Monday to Friday, 8 hours a day. CONCLUSION: Adequate choice of contraceptives were not available and the information provided to the clients was insufficient. Based on the findings it is recommended to increase the number of methods; provide sufficient information to clients; increase community based reproductive health service sites; and give additional training for the providers so that they can give quality family planning service in their area.     

Gender-besed violence among high school students in north west Ethiopia

BACKGROUND: Gender-based violence exists in all societies and individual woman experience it in every social and economic group. Different studies in Africa have showed that there are significant percentages of females that have suffered from the violence. Most societies encourage manifestation of manliness through violence in workplace, among friends and in the community as a whole. OBJECTIVE: The study tried to see the prevalence of Gender-based Violence and the various patterns and correlates of Gender-Based Violence among female high-school students, Northwest Ethiopia. METHODOLOGY: This study is a cross--sectional study done on 367 female high--school students who were given self-administered questionnaires to assess the prevalence of gender-based violence against these students in Dabat High school. RESULT: This study showed 11.4% of the students have started sexual intercourse and of these, 33.3% were raped cases. Twenty percent (20.4%) from the total of 367 students have survived attempted rape. In addition 44% of the students were sexually harassed. Among the study participants considerable proportion are mainly responsible for the housework. Around 8% of the students have undergone Female Genital Mutilation. CONCLUSION: Generally, the prevalence of gender-based violence is high in Dabat High-School, Northwest Ethiopia and attention should be given by policy-makers and law enforcing bodies to adequately address the problem.     

Marriage through abduction ('Telefa') in rural north west Ethiopia

A community based cross sectional study was conducted in a rural district of North West Ethiopia between February and April 1997 to determine the magnitude of marriage through abduction ('Telefa') and identify problems associated with it. Randomly selected and currently married 1,168 women were interviewed. The prevalence of marriage through abduction was 6.2% (72/1168). All the abductions reported were only once in lifetime during the first marriage. The median age at first marriage of abducted women was 13 years with a range of 13 (Minimum = 7 and Maximum 20). About two third (66.7%) of abducted women had been married more than once in their life time. Following a multivariate analysis in a logistic regression model abducted women were likely to be victims of abortion [Adjusted OR (95% CI) = 1.71 (1.10-3.05)], marital instability [Adjusted OR (95% CI) = 1.87 (1.10-3.18)], rape [Adjusted OR (95% CI) = 7.77 (3.78-15.95)] and domestic violence [Adjusted OR (95% CI) = 1.69 (1.11-2.81)]. The recognition of the magnitude and the associated health problems of marriage through abduction (Telefa) is important. Appropriate strategies that address the health needs of abducted women must be designed. Enforcing the judiciary system to discourage this harmful practice and empowerment of young girls and rural women is needed.     

Asymtomatic bacteriuria in pregnancy: assesment of prevlence, microbial agents and ther antimicrobial sensitivty pattern in Gondar Teaching Hospital, north west Ethiopia

OBJECTIVE: To estimate the prevalence of asymptomatic bacteriuria in pregnant women, identify the frequently isolated uropathogenic bacteria and its antimicrobial sensitivity pattern. PATIENTS AND METHODS: This cross-sectional case series study was conducted in antenatal care clinic of Gondar Teaching Hospital from June-Oct., 2001. One hundred and seventy three pregnant women, who met the inclusion criteria, were included in the study after informed consent was obtained Clinical information pertaining to socio demographic data and obstetric history was filled in the questionnaire, pertinent physical examination was done and urine specimen from each candidate was collected and processed following the standard microbiological technique. RESULT: Majority (70-90%) of the pregnant women were literate, housewives, married and residents of Gondar town. Of all pregnant women included in the study, 96/173 (56%) were multigravida, and 21/173 (12%) had 5 or more pregnancies. The identification rate of significant bacteriuria in the study group was 9.8% (17/173) with higher rate (20.5%) in multiparous mothers. The frequently isolated urinary pathogenic bacteria was E. coli, 47% (8/17), followed by S. aureus 3/17 (18%) and C. freundi 2/17 (12%). The majority of E. coli isolates (50-75%) were resistant to gentamicin, Ampicillin, trimethoprim-sulphamethoxazole, tetracycline, and chloramphenicol; while 75% and 100% of E. coli isolates were sensitive to cefoxitin, and ciprofloxacin respectively. CONCLUSION: Asymptomatic bacteriuria in pregnant women was prevalent in the study locality. E. coli was the common isolated urinary pathogen among urine samples of study subjects, and was found to be resistant to multiple antimicrobial agents. We suggest cefoxitin should be the drug used to treat significant bacteriuria in pregnant women in the study locality.     

Genitourinary and rectovaginal fistulae in Adigrat Zonal Hospital, Tigray, north Ethiopia

This study was carried out to determine the type frequency, cause and treatment outcome of patients with genitourinary and rectovaginal fistulae at Adigrat Zonal Hospital. A retrospective review of charts and operating room records of patients admitted for genitourinary and/or rectovaginal fistula to the gynecological ward of the study Hospital from April 1, 1993 to March 30, 2001 was conducted. There were a total of 1,011 patients on whom major gynecological surgeries were done in the same period of time in the hospital. Among these 201(19.9%) patients were operated for genito urinary and rectovaginal fistulae. Eight cases were excluded because of incomplete records. Out of the remaining 193 cases, 95.3% were due to obstetric etiology. One hundred sixty six (86%) had vesicovaginal fistula, 16 (8.3%) both vesico vaginal fistula and rectovaginal fistula, 9 (4.7%) recto vaginal fistula, one vault fistula and one vesicouterine fistula. Primigravidae accounted for 47.3% of obstetric fistula and teenage constituted 40% of the cases. Among the patients with obstetric fistula, 92.4% had no antenatal care and 42.4% delivered in health institutions. Of the 182 patients with vesico vaginal fistula, surgical intervention after the first intention was successful in 86.8%, failed in 4.9% and stress incontinence developed in 8.2% of cases. The success rate of fistulae repair in district hospital is comparable to results from specialized setup. Repair integrated into rural hospital services could reduce cost and time spent by patients traveling to specialized units.     

Magnitude and pattern of injuries in north Gondar administrative zone, northwest Ethiopia

A prospective study was carried out between April and July 2000 in North Gondar administrative zone, Northwest Ethiopia, to assess the magnitude, pattern, outcome and burden of injuries. All trauma victims presenting to twenty health institutions were included. Of 37026 patients registered, 1982 (5.4%) presented with injury as main complaint. Trauma constituted about 46% of surgical patients, which shows a significant burden to the institutions. Seventy three percent of the injured patients were males. The leading cause of injury was assault (48.5%) followed by fall down injury (18.6%) and road traffic injuries (14.7%). Of the vehicle related injuries, 59.6% were caused by commercial vehicles. Admission was required in 15.2% of the injured patients. An average of 4.2 hours was required for initial outpatient management. The average hospital stay for the admitted patients was twelve and half days. In this and other parts of Ethiopia, injury prevention efforts should focus on assault, falls and transport safety with special attention to commercial vehicles. A community-based study is also recommended to explore the burden of trauma on the general community.     

Environmental determinants of diarrheal morbidity in under-five children, Keffa-Sheka zone, south west Ethiopia

A population-based cross-sectional study on diarrheal morbidity was carried out in thirty two rural and urban areas of Keffa-Sheka zone, to determine the prevalence of diarrhea in under-5 children and identify environmental risk factors. A total of 952 children between the ages of 0 and 59 months living in the sampled households formed the study population. Data collected include demographic characteristics of the child, and information on environmental and housing variables. The overall diarrheal prevalence was 15%. Acute watery diarrhea, dysentery, and persistent diarrhea were responsible for 66%, 20%, and 14% of the episodes, respectively. Overall a third of the diarrheal episodes were bloody and/or persistent. Young age, male gender, living in a house with fewer number of rooms, and obtaining water from storage containers by dipping showed statistically significant association with diarrheal morbidity (p < 0.05). Type of water source, amount of water consumed, and latrine availability were not found to be significant risk factors (p > 0.05). Diarrhea, particularly dysentery and/or persistent diarrhea, affect a large proportion of children. Water is scarce and the environmental status of the area is generally poor. Efforts to educate the community about correct water handling behavior, personal and domestic hygiene should also be important components of the diarrhea control strategy. Further study on other environmental determinants, socio-demographic factors, feeding patterns and immunization status of children, and ORS accessibility is also recommended.     

全自动单剂量摆药机实施效果评价

目的 评价全自动单剂量摆药机在我院住院药房的实施效果.方法 对比我院住院药房全自动药品单剂量分包机和全自动针剂摆药机使用前、后10个工作日内,5个科室2种摆药模式的用时差异.结果 片剂机器摆药总用时均较人工摆药总用时由(1.12+0.57) min减少至(0.56±0.34)min,针剂机器摆药总用时均较人工摆药总用时由(2.02 +0.54) min减少至(0.72±0.23) min,片剂摆药药师由原来的8人减少至4人,针剂摆药药师由原来的5人减少至1人.结论 全自动单剂量摆药机具有具有方便、卫生、快捷、准确等优点,提高了医院药学服务水平,是医院药房的发展趋势.     

Immediate or deferred adjustment of drug regimens in multidose drug dispensing systems

Background

Multidose drug dispensing (MDD) is used to help patients take their medicines appropriately. Little is known about drug regimen changes within these MDD systems and how they are effectuated by the community pharmacist. Manual immediate adjustments of the MDD system could introduce dispensing errors. MDD guidelines therefore recommend to effectuate drug regimen changes at the start of a new MDD system.

Determinants of potential drug–drug interaction associated dispensing in community pharmacies in the Netherlands

Objective: There are many drug–drug interactions (D–DI) of which some may cause severe adverse patient outcomes. Dispensing interacting drug combinations should be avoided when the risks are higher than the benefits. The objective of this study was to identify determinants of dispensing undesirable interacting drug combinations by community pharmacies in the Netherlands. Methods: A total of 256 Dutch community pharmacies were selected, based on the dispensing of 11 undesirable interacting drug combinations between January 1st, 2001 and October 31st, 2002. These pharmacies were sent a questionnaire by the Inspectorate for Health Care (IHC) concerning their process and structure characteristics. Main outcome measure: The number of times the 11 undesirable interacting drug combinations were dispensed. Results: Two hundred and forty-six questionnaires (response rate 96.1%) were completed. Dispensing determinants were only found for the D–DI between macrolide antibiotics and digoxin but not for the other 10 D–DIs. Pharmacies using different medication surveillance systems differed in the dispensing of this interacting drug combination, and pharmacies, which were part of a health care centre dispensed this interacting drug combination more often. Conclusion: Medication surveillance in Dutch community pharmacies seems to be effective. Although for most D–DIs no determinants were found, process and structure characteristics may have consequences for the dispensing of undesirable interacting drug combinations.