Application of assistance methodology in patients suffering systemic lupus erythematosus in drug pulse therapy: a teaching experience

This research is an experience report of clinical teaching for undergraduate nursing students, to whom it was used the assistance methodology as a teaching strategy It was applied in adults, suffering Systemic Erythematosus Lupus, young women, in majority, who were submitted to drug pulse therapy, a therapeutic modality which, through immunesuppression, reduces the inflammatory process caused by self antibody. This way, the assistance is systemized, individualized and integral and it allows single opportunities of theoric-pratic correlation for the students, with the application of basic knowledge of the formation area, context of the health-disease process and the focus going beyond the biologic, including emotional, social and spiritual aspects and opportunities for the student to evaluate several factors that interfere in the assistance conditions offered by public health services.     

Estimates of pregnancies averted through California's family planning waiver program in 2002

CONTEXT: During its first year of operation (1997-1998), California's family planning program, Family PACT, helped more than 750,000 clients to avert an estimated 108,000 pregnancies. Given subsequent increases in the numbers of clients served and contraceptive methods offered by the program, updated estimates of its impact on fertility are needed. METHODS: Claims data on contraceptives dispensed were used to estimate the number of pregnancies experienced by women in the program in 2002. Medical record data on methods used prior to enrollment were used to predict client fertility in the absence of the program. Further analyses examined the sensitivity of these estimates to alternative assumptions about contraceptive failure rates, contraceptive continuation and contraceptive use in the absence of program services. RESULTS: Almost 6.4 million woman-months of contraception, provided primarily by oral contraceptives (57%), barrier methods (19%) and the injectable (18%), were dispensed through Family PACT during 2002. As a result, an estimated 205,000 pregnancies-which would have resulted in 79,000 abortions and 94,000 births, including 21,400 births to adolescents-were averted. Changing the base assumptions regarding contraceptive failure rates or method use had relatively small effects on the estimates, whereas assuming that clients would use no contraceptives in the absence of Family PACT nearly tripled the estimate of pregnancies averted. CONCLUSION: Because all contraceptive methods substantially reduce the risk of pregnancy, Family PACT's impact on preventing pregnancy lies primarily in providing contraceptives to women who would otherwise not use any method.     

Factors interfering in the experience of women in childbirth process and in childbirth

Childbirth is a relevant happening in a woman's life, as it is a unique moment for the mother-child binomial. This study aimed at understanding the factors that interfere in the experience lived by childbearing women. Seven women who gave birth through normal childbirth in a public maternity in Fortaleza-Ceará participated in the study. Data were collected from June to August, 2003. Ethnonursing was the method used for data collection and analysis. The findings were reflected in the framework of Leininger's Diversity and Universality of Cultural Care Theory, which were organized in three categories: Fear; Influence of the beliefs and religiosity; previous pregnancy. The practice of cultural care to women showed the importance of communication and consideration of women's beliefs and values at the moment of the childbirth process and delivery.     

The abortion paradox in Uganda: fertility regulator or cause of maternal mortality.

Both fertility and maternal mortality indices are high among Ugandan mothers. The expected benefits in fertility and maternal mortality reduction from a rising contraceptive uptake in the country (from 5% in 1991 to 23% by the year 2000) have not been forthcoming because the increase in contraceptive prevalence rate (CPR) was below the critical level required to cause any meaningful change in overall fertility and maternal mortality. The strong desire among couples to limit family size coupled with the lack of access to modern methods of contraception by many women, especially in the rural areas of the country, have contributed to the increasing use of abortion as a means of averting unplanned or mistimed motherhood. In contrast to the expected results of a typical fertility regulator, however, abortion seems to up-regulate instead of down-regulate the occurrence of maternal mortality. This paradoxical relationship is explained mainly by the illegality of the procedure, which converts it to a clandestine activity performed by poorly trained individuals operating, in many instances, in septic settings. A practical solution is to make modern and effective methods of contraception widely available, especially among rural-dwellers. Through this and coupled with training of personnel, as well as demystification of abortion by dismantling the stigma of "illegality" associated with it, down-regulation of fertility and maternal mortality can both be achieved in a country like Uganda where population explosion is further complicated by a high incidence of maternal demise.     

‘What kind of life is this?’ Diabetes related notions of wellbeing among adults in eastern Uganda and implications for mitigating future chronic disease risk

Background

Effective prevention and care for type 2 diabetes requires that people link healthy behaviours to chronic disease-related wellbeing. This study explored how people perceive current and future wellbeing, so as to inform lifestyle education.

Methods

Eight focus group discussions and 12 in-depth interviews were conducted in Iganga and Mayuge districts in rural Eastern Uganda among people aged 35–60?years in three risk categories (1) People with diabetes, (2) people at higher risk of diabetes (with hypertension or overweight) and (3) community members without diabetes.

Results

People define wellbeing in three notions: 1) Physical health, 2) Socio-economic status and 3) Aspirational fulfilment. Most people hold the narrower view of wellbeing that focuses on absence of pain. Most overweight participants did not feel their condition as affecting their wellbeing. However, for several people with hypertension, the pains they describe indicate probable serious heart disease. Some people with diabetes expressed deep worry and loss of hope, saying that ‘thoughts are more bothersome than the illness’. Wellbeing among people with diabetes was described in two perspectives: Those who view diabetes as a ‘static’ condition think that they cannot attain wellbeing while those who view it as a ‘dynamic’ condition think that with consistent treatment and healthy lifestyles, they can be well. While many participants perceive future wellbeing as important, people without diabetes are less concerned about it than those with diabetes. Inadequate knowledge about diabetes, drug stock-outs in health facilities, unaffordable healthier food, and contradictory information were cited as barriers to future wellbeing in people with diabetes.

Conclusions

To make type 2 diabetes prevention relevant to healthy people, health education messages should link current lifestyles to future wellbeing. Diabetes patients need counselling support, akin to that in HIV care, to address deep worry and loss of hope.

     

Persistent high fertility in Uganda: young people recount obstacles and enabling factors to use of contraceptives

Background  

High fertility among young people aged 15-24 years is a public health concern in Uganda. Unwanted pregnancy, unsafe induced abortions and associated high morbidity and mortality among young women may be attributed to low contraceptive use. This study aims at exploring reasons for low contraceptive use among young people.     

Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

Background

Geographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders.

Methods

This quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented.

Results

Motorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing.

Conclusions

Transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.

     

Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda

Abstract

Unsafe abortion in Africa continues to be a major contributor to the global maternal mortality which affects young women in particular. In Uganda, where abortion is legally restricted and stigmatised, unsafe abortion is a major public health issue. We explored reproductive agency in relation to unsafe abortion among young women seeking post-abortion care. Through in-depth interviews we found that reproductive agency was constrained by gender norms and power imbalances and strongly influenced by stigma. Lack of resources and the need for secrecy resulted in harmful abortion practices and delayed care-seeking. Women did not claim ownership of the abortion decision, but the underlying meaning in the narratives positioned abortion as an agentive action aiming to regain control over one′s body and future. Women′s experiences shaped contraceptive intentions and discourse, creating a window of opportunity that was often missed. This study provides unique insight into how young women negotiate and enact reproductive agency in Uganda. Health systems need to strengthen their efforts to meet young women’s sexual and reproductive health needs and protect their rights. Enabling young women’s agency through access to safe abortion and contraception is paramount.