北京社区妇女3年内宫颈病变初次及再次筛查结果分析

目的本研究通过对北京市社区妇女3年的随访资料,研究北京社区妇女宫颈病变的状况。方法 2006年和2009年分别对北京市西城区展览路社区225名20～54岁有性生活的妇女,用相同的方法进行宫颈病变初次筛查及再次筛查。应用液基细胞学（LCT）、高危型人乳头状瘤病毒（HPV）检测,对宫颈细胞学异常（≥ASC-US）者行阴道镜及活检病理检查,并将两次筛查结果进行分析。结果①2006年初筛细胞学异常者15例,其中HPV阳性者9例。2009年再次随访筛查,细胞学异常者7例,细胞学阴性者218例;②细胞学变化：细胞学转阴者14例（14/225）,除2例（1例湿疣、1例CIN2）经激光治疗及2例CIN3行宫颈锥切术外,其余10例均未予干预。细胞学转阳者6例（6/225）,其中发现1例湿疣及3例慢性宫颈炎,其余2例拒绝阴道镜检查。细胞学均阳性者1例（1/225）,HPV结果均为阳性,病理结果为慢性宫颈炎。细胞学均阴性者为204例;③HPV检测结果及变化：两次筛查HPV阳性者34例（15.1%）。HPV均阴性者178例（79.1%）。结论在北京社区妇女宫颈病变的筛查中,细胞学及HPV均阳性者,宫颈病变的可能性大。对病变妇女应尽早干预并建议进行包括HPV检测的定期随访追踪。     

Characteristics of traditional midwives and their beliefs and practices in rural Bangladesh

This study has analyzed the characteristics, beliefs and practices of midwives in rural Bangladesh. The midwives were mainly above age 30, married or widowed, and illiterate. Most of them learned their midwifery from informal sources such as female relatives or neighbours. Often, during pregnancy, childbirth, and post-partum period, midwives imposed dietary restriction on the mothers. Similarly, devices used in the cutting of the umbilical cord and placenta were not properly sterilized and potentially dangerous substances were applied at the navel after cutting the umbilical cord or placenta. There was a practice of withholding breast-feeding up to 3 days after the birth of a child. However, there were also some beliefs or practices among the midwives that could be regarded as based on scientific understanding such as the practice of cutting the umbilical cord by boiled razor blade or the belief that child death could occur from tetanus caused by the unsterilized device used in the cutting of the umbilical cord.     

Prenatal herpes simplex virus serologic screening beliefs and practices among obstetricians

OBJECTIVE: To describe the beliefs and practices of obstetricians related to prenatal serologic testing for HSV infection. METHODS: A total of 265 (73% of eligible) currently practicing obstetricians in Washington State completed a 36-question mailed survey that assessed beliefs regarding genital herpes in pregnancy, neonatal herpes, serologic testing for herpes in pregnancy, and ease of testing. RESULTS: Ninety-five percent of respondents believed genital herpes was common in reproductive-aged women, 83% believed neonatal herpes was a serious health issue, and 73% believed it warranted systematic prevention efforts; 74% discussed herpes with pregnant patients as part of prenatal care, 31% provided written materials about herpes, and 15% used serologic tests for herpes in 75% or more of their prenatal patients. Factors independently associated with routine herpes serologic testing were academic practice setting (adjusted odds ratio [aOR] 10.4, 95% confidence interval [CI] 2.8-39.1) and metropolitan practice setting (aOR 3.3, 95% CI 1.4-7.9). Beliefs that testing would cause unnecessary distress in pregnancy (aOR 0.3, 95% CI 0.1-0.7), or that testing was not worth the expense (aOR 0.1, 95% CI 0.0-0.6) were associated with not testing. Availability of serologic tests for HSV was reported to be high and was not associated with prenatal HSV testing. CONCLUSION: Most obstetricians believe neonatal herpes prevention is important. LEVEL OF EVIDENCE: II.     

Knowledge and attitude to cervical cancer screening among women in Maiduguri, Nigeria.

Five hundred women were studied to determine their knowledge of cervical cancer. Less than 10% of the women were aware of the disease or its symptoms. Even fewer were aware of cytological screening, the good results obtained in the premalignant stage and early invasive stages of the disease. Simple explanation showed a good recall at 4-6 weeks. At that time women would accept screening and understood its importance. This study shows clearly that education must precede a screening programme if it is to succeed.     

Postpartum beliefs and practices in Danbare village, Northern Nigeria.

Postpartum cultural beliefs and practices are widely prevalent in northern Nigeria. Using a cross-sectional survey, we set out to examine contemporary postpartum beliefs and practices among a cohort of 300 mothers in Danbare village, northern Nigeria. Common postpartum practices included sexual abstinence (100%), physical confinement (88%), hot ritual baths (86%), nursing in heated rooms (84%) and ingestion of gruel enriched with local salt (83%). The majority of mothers (93%) believed that these practices made them stronger and helped them regain their physiologic state. Most respondents believed that non-observance could lead to body swelling, foul-smelling lochia and perineal pain. Mothers with formal education were significantly more likely to believe that these practices were non-beneficial compared with those mothers without formal education (odds ratio (OR) = 9.9, 95% confidence interval (CI) = 3.6 - 28.8). Almost half of the respondents (49%) said they would continue with these practices. In conclusion, women are still holding on to postpartum cultural beliefs and practices in northern Nigeria. However, educated women could act as useful agents of change towards the elimination of practices harmful to the health of mothers and their children.     

Evaluation of cervical screening in rural North India

Objective

To assess the accuracy of cervical screening with visual inspection and cytology testing, and the cure rate of cervical intraepithelial neoplasia (CIN) after treatment, in a rural population in North India.

Methods

A cross-sectional study evaluated the detection rates of CIN 2 and CIN 3 lesions by cytology testing and by visual inspection of the cervix following the application of 5% acetic acid (VIA) or Lugol's iodine (VILI). It also evaluated the cure rates following treatment of CIN.

Results

Of 5050 women approached in 17 villages, 3000 (59.4%) participated (range, 41%-91%). Of these, 14.2% were positive by VIA, 15.6% by VILI, and 5.4% by cytology testing at ASCUS threshold, and 37 women were diagnosed as having CIN 1 and 20 as having CIN 2 or CIN 3. Detection rates of CIN 2 or 3 using VIA, VILI, and cytologic findings of ASCUS and LSIL were 3.7, 3.3, 4.5, and 4.2 per 1000 women, respectively, and 91.4% of the treated women were cured.

Conclusion

Both VIA and VILI were found to be accurate screening tests and the cure rates for CIN were satisfactory.     

Motivations and preferences of rural Nigerian women undergoing cervical cancer screening via visual inspection with acetic acid

ObjectiveTo determine the motivations and preferences of women participating in visual inspection with acetic acid (VIA) mass cervical cancer screening programs in southeastern Nigeria.MethodsBy means of interviewer-based questionnaires, data were collected from women participating in mass cervical cancer screenings with VIA in 3 randomly selected communities in each of 2 southeastern Nigerian states between March 1, 2011, and March 31, 2012.ResultsA total of 2312 women were interviewed. Support from husband and community opinion leaders were the most frequently reported factors that motivated the women to participate in the screening. Most participants expected an immediate result for the screening test and immediate treatment for any abnormalities detected.ConclusionCommunity-based advocacy for cervical cancer screening is a very effective method of creating awareness for cervical cancer screening. Support from spouses and community leaders are important factors in a woman's decision to utilize cervical cancer screening services in southeastern Nigeria. Immediate results and treatments would make the most impact. Family and community participation should be integrated into cervical cancer prevention programs. This, together with a “see and treat” approach, may be central to overcoming the poor utilization of cervical cancer screening services in Nigeria and similar rural settings.     

Nutrition of pregnant women in rural and urban areas

The purpose of the study was to gain information on the present state of nutrition of pregnant women in rural areas and towns, and on the level of their knowledge of adequate nutrition. The study covered 300 women in villages and 258 in towns. The selection of women was done randomly, the method of the study was interviewing of the women. The questions concerned consumption of milk, cheese, meat and its products, eggs, vegetables and fruit during the whole pregnancy, and separately the data on potato consumption were obtained. The women were questioned also about the read publications on rational nutrition of pregnant women. The answers were obtained from mothers aged 18-42 years in labour rooms, clinics for children or in homes. The answers were noted during interviews by experienced interviewers. It was found that 26.6% of pregnant women in towns and 16.2% in villages were not consuming daily milk or cheese, while 6.2% of these women in towns and 4.3% in villages consumed no milk at all. Only 41.1% of these women in towns and 19% in villages took meat and processed pork everyday. Most frequently the women consumed meat and processed pork 4 times weekly (39.6% in towns and 60.3% in villages). Eggs were consumed daily by only 13% of women in towns and villages, and they were eaten most frequently 4 times weekly (30.2% in towns and 45.7% in villages). In a week meat, processed pork and eggs were eaten 5 to 7 times by only 43.8% of pregnant women in towns and 21.3% in villages.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sociologic problems of contraception in the opinion of women from urban and rural areas

The paper, having a diagnostic character, discusses the problems of birth control, family planning and contraception methods. The methods of the investigation were a questionnaire, interview and analysis of documentation. The investigation was carried out in two areas: urban--Katowice and rural--Istebna. The investigation was carried out among a group of 100 women between 20 and 55 years of age. All the women questioned have been married for 1-30 years. Most of them have two children--30%. Most women from both the urban and rural areas use natural methods of contraception, in. the town--Billings method and in the country--conjugal diary. Thermal method is less popular as it is time-consuming. The main reasons for choosing a natural method of contraception control are moral, religious and biological aspects, which give the women a psychic comfort and a strong feeling of attachment to the husband. Women from the urban area say that they started to use contraceptive methods after getting married whereas women from the rural area--after giving birth to a child. Contraceptive devices are used by about 30% of women. The most popular are: among women from the town--coitus interruptus, artificial abortion and less popular contraceptive devices such as oral contraceptives, intrauterine devices and chemical substances. Among women from the rural area the most common is coitus interruptus and then 2-1 cases of each of the remaining methods. Women applying contraceptive devices are aware of their harmful effects, their unreliability, immorality and violating nature. Women in the country face a lot of difficulties in buying contraceptive devices and they also (22%) use artificial abortion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Midwives' practices and beliefs about discharging clients from their practice

Discharging a client from a practice is a choice clinicians may need to make when conflicts arise that cannot be resolved. The legal and ethical considerations before discharging a client are presented. This preliminary survey of 111 certified nurse-midwives was conducted to determine their practices and beliefs about discharging clients. Most (83.7%) participants had discharged five or fewer clients from their practice throughout their careers, including 36.9% who had never discharged a client from their practice. In contrast, 77.5% of participants said that midwives should definitely discharge clients from their practice under some circumstances. Antepartum care was the most frequent period during which clients were discharged, and 59% of those discharged were for noncompliance with the therapeutic regimen, obnoxious or abusive behavior as subjectively identified by the midwife and her colleagues, or failure to keep appointments. When asked why they might not discharge a client from their practice, 60% identified empathy or sympathy for the client as the reason. When asked why they did not discharge clients in the past, 23 (21%) respondents selected "colleagues disagreed" as the reason.     

Participation in highly subsidized cervical cancer screening by women in Enugu, South-east Nigeria.

The current study was designed to evaluate the level of participation in a highly subsidized cervical screening in a resource-poor country. A total of 989 cervical smears performed on 932 women in Enugu, South-east Nigeria, over a 10-year period (January 1995-December 2004) was reviewed. The level of participation in cervical screening was very low, as <1% of the targeted women population participated. Almost 68% of the participants were referred for the screening and the majority (52.3%) were from lower social classes because the programme was highly subsidized. A total of 646 (65.3%) smears were normal. Of the abnormal smears, 193 (19.5%) had non-specific inflammatory changes, 136 (13.8%) showed dyskaryotic cells while 14 (1.4%) had neoplastic changes. A total of 57 (6.1%) women had more than one cervical cancer screening and they were characterised by increasing age, up to 59 years, higher social classes and contraceptive users in lower social classes. To reverse the low level of participation in cervical cancer screening in developing countries, there is a need to provide highly subsidized (if not free) cervical cancer screening services, which must be followed by sustained cervical cancer awareness campaign.     

Clean delivery practices in rural northern Ghana: A qualitative study of community and provider knowledge, attitudes, and beliefs systems

ABSTRACT: BACKGROUND: Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing / use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. METHODS: In-depth interviews and focus group discussions with community members were audiotaped, transcribed, and analyzed using NVivo 9.0 RESULTS: 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools; the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or "red earth sand." Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. CONCLUSIONS: This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success.     

Self-reported reproductive outcome and implications in relation to use of care in women in rural Zimbabwe

BACKGROUND: In order to assess morbidity and health care utilization in developing countries, health interview surveys are often used. The aim of this paper is to explore morbidity, health care utilization during pregnancy and pregnancy outcome as reported by women in rural Gutu district, Zimbabwe. METHODS: The study was cross-sectional, performed 1992-93 in 12 villages selected at random. Women aged 15-44 years (n = 1213) were interviewed concerning their reproductive history, use of maternity care and complications during pregnancy/labor during their latest pregnancy. RESULTS: The perinatal mortality rate (PMR) for all the completed pregnancies (889 women had completed 3601 pregnancies) was 23/1000 total births. The attendance rate for antenatal care was high (94%). Elevated blood pressure was the most commonly reported late pregnancy complication, and a prolonged labor, i.e. 24 h or more, the most common complication during delivery. Out of women whose latest pregnancy did not end in an early or late abortion (n = 831) the cesarean section rate was 6.3%. The PMR was 8.4/1000 for their latest pregnancy. Institutional deliveries were preferred by the majority of women, with hospital and clinic deliveries constituting 58% and 27% of deliveries, respectively, while 15% delivered at home. Long-term complications were few, and only 14 (1.6%) women reported a current health problem, which they related to previous pregnancies. CONCLUSIONS: Antenatal attendance rate was high. The majority of women preferred institutional deliveries. Few women reported complications, which were not taken care of in the health service. Long-term complications related to previous pregnancies were few.