Male sex workers (MSWs) in Zimbabwe are a vulnerable sub-group at risk of violence, abuse, and HIV infection. This qualitative study examines the practices of male sex workers and vulnerabilities to ...HIV infection based on interviews among 15 MSWs in Bulawayo. All the interviews were recorded, transcribed, and analyzed with the guidance of grounded theory. The transcripts were translated by the interviewer into English using NVivo 11.0 software for coding and analysis. The MSWs interviewed reported diverse backgrounds in sexual orientation and life situations, plus a variety of work settings, income levels and access to clients. Due to the illegal nature of sex work and the stigma of homosexuality, practices in the sex trade are often hidden and subtle to avoid exposure to the police. Some develop romantic relationships with regular clients, but more typically they suffer abuse, violence, and the threat of sexually transmitted diseases, including HIV. Most Zimbabwean MSWs are ill-informed and underestimate their vulnerability of HIV. The stigmatization and criminalization of homosexuality in Zimbabwe creates an environment where it is difficult for MSWs to protect themselves through consistent condom use and access to basic HIV prevention and care services.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The Gambia has the 12
highest maternal mortality rate in the world, with 80% of deaths resulting from avoidable causes. Unawareness of pregnancy danger signs (DS) has been shown to be a barrier to ...seeking obstetric care, while app-based education intervention has shown promise.
We aim to assess patient awareness of DS, identify barriers to awareness, and evaluate potential for implementing smartphone-based technologies for education.
A cross-sectional semi-structured survey was administered to Gambian women (n = 100) across five hospitals/health centers. Data and informed consent were collected via an online survey portal. Analysis included bivariate analysis and descriptive statistics with p < 0.05 significance level. Recall of 0-2 DS per category was classified as "low" knowledge, 3-5 as "moderate" knowledge, and 6+ as "sufficient" knowledge. Cross-category recall was quantified for overall awareness level (0-6 = "low", 7-12 = "moderate", 13+ = "sufficient". N = 28 total DS).
Although 75% of participants (n = 100) self-perceived "sufficient" knowledge of DS, the average recall was only two (SD = 2, n = 11) pregnancy DS, one labor and delivery DS (SD = 1, n = 8), and one postpartum DS (SD = 1, n = 9). Twenty-one women were unable to recall any danger signs. "Low" awareness was identified in 77% of women, while 23%, and 0% of women showed "moderate" and "sufficient" overall awareness, respectively. Education level was significantly correlated with overall danger sign recall (ρ(98) = .243, p = .015) and awareness level (ρ(98) = .265, p = .008). Monthly income was significantly correlated with awareness level (ρ(97) = .311, p = .002). Smartphone ownership was reported by 76% of women, and 97% expressed interest in using app-based video (94%) or provider (93%) teaching.
Women had low knowledge of obstetric danger signs, and true awareness of danger signs was remarkably lower than self-perceived knowledge. However, patients exhibited proper healthcare-seeking behavior when danger signs arose. Findings suggest that video- or messaging-based education from local healthcare providers may be effective DS educational interventions.
During the 2019 Anti-Extradition Law Amendment Bill (Anti-ELAB) movement, parents generally supported government efforts to maintain order while their adult children allied themselves with the ...protesters. Conventional literature on social movements-particularly for Hong Kong-tends to focus on macropolitical aspects such as the causes of the social movement, evolutionary processes, and macro-political structures. This article suggests that ＂practices of intimacy＂ can supplant hierarchical power relations in the family, enabling both parents and children to resolve problems of intergenerational conflict. By analyzing the results of 63 in-depth interviews and three focus groups between the parents and young adult children, this article identifies the stresses in family relationships and then highlights ways to relieve them through the lens of restored intimacy. This research may offer clues for Hong Kong policy makers to reestablish social cohesion.
Objective
To determine the success rate and factors that result in a negative dye test after extended bladder catheterization after surgery for obstetric fistula.
Methods
A retrospective cohort study ...was carried out on women who underwent obstetric fistula repair in Malawi and had ≥14 days of bladder catherization. Variables such as age, class of fistula, previous repairs, menopausal status, and HIV status were examined for association with successful healing at the end of the catheterization period.
Results
Fifty‐two patients had a positive dye test after the intended period of catheterization and the catheterization period was extended by 7 days. Of these patients, 29 (55.7%) had a subsequent negative dye test. Older women (mean age 28.4 years) who developed a fistula were more likely to have a negative dye test after extended catheterization, compared to their younger counterparts (mean age 20 years) (P=0.0018). Other variables were not found to be significantly different between the two groups.
Conclusion
More than half of the patients with a positive dye test had complete closure of the fistula defect after an extension of bladder decompression. It is reasonable to consider an extension of bladder catheterization for 7 days after an initial positive dye test.
After a failed vesicovaginal fistula surgery, it is reasonable to consider extending bladder catheterization for 7 days.
•Data on surgical outcomes and complications of radical hysterectomy in low-income countries (LICs) is scant.•Extensive retroperitoneal fibrosis following radical hysterectomy and pelvic ...lymphadenectomy can complicate fistula repair.•Fistula repair following radical hysterectomy can require complex urogenital reconstruction techniques.•Fistula repair following radical hysterectomy can require extensive bowel surgery.
Complications from radical hysterectomy in low-income countries (LICs) are largely unreported in the medical literature. We report on three cases of urinary tract reconstruction performed at the Fistula Care Center (FCC) in Lilongwe, Malawi for iatrogenic fistula following radical hysterectomy. These cases demonstrate the diversity and complexity of reconstruction techniques required and emphasize the need for careful tracking of surgical outcomes of radical hysterectomy.
Persistent depression after obstetric fistula repair Stokes, Mary J.; Wilkinson, Jeffrey P.; Ganesh, Prakash ...
International journal of gynecology and obstetrics,
November 2019, 2019-Nov, 2019-11-00, 20191101, Letnik:
147, Številka:
2
Journal Article
Recenzirano
Objective
To measure depression over time using the Patient Health Questionnaire 9 (PHQ‐9) and identify characteristics associated with persistent depression.
Methods
A database of women undergoing ...obstetric fistula repair was used to examine associations between depression and variables such as demographics, type of fistula, and postoperative continence status.
Results
A total of 797 patients completed the PHQ‐9 at the initial preoperative assessment; 365 (45.8%) had a PHQ‐9 score of 5 or higher, indicating depression. Preoperatively, depression was associated with women aged 18–34 years, with no children, and with fistula for 5 years or less. Postoperatively, depression was associated with persistent incontinence. Over time, however, depression was rarely found among women returning for follow‐up.
Conclusion
Postoperative depression decreased over time in women who returned for follow‐up, either due to selection bias or due to improved adjustment to one's circumstances. This study underscores the need for ongoing follow‐up, especially for those not presenting for care or with persistent incontinence.
Women with incontinence after obstetric fistula repair remain at risk of depression; long‐term follow‐up and support, however, may improve depression without formal mental health intervention.
Obstetric fistula affects a woman's life physically, psychosocially, and economically. Although surgery can repair the physical damage of fistula, the devastating consequences that affect a woman's ...quality of life may persist when she reintegrates into her community. This qualitative study assessed long-term outcomes among women who underwent obstetric fistula repair in Malawi. We explored three domains: overall quality of life before and after repair, fertility and pregnancy outcomes after repair, and understanding of fistula.
In-depth interviews were conducted in Chichewa with 20 women from seven districts across Central Malawi. All women were interviewed 1 to 2 years after surgical repair for obstetric fistula at the Fistula Care Centre in Lilongwe, Malawi. Interviews were independently coded and analyzed using content analysis.
About half of women were married and nine of 20 women reported some degree of urinary incontinence. With the exception of relationship challenges, women's concerns before and after repair were different. Additionally, repair had resolved many of the concerns women had before repair. However, challenges, both directly and indirectly related to fistula, persisted. Improvements in quality of life at the individual level included feelings of freedom, confidence and personal growth, and improved income-earning ability. Interpersonal quality of life improvements included improved relationships with family and friends, reduced stigma, and increased participation with their communities. Nearly half of women desired future pregnancies, but many were uncertain about their ability to bear children and feared additional pregnancies could cause fistula recurrence. Most women were well informed about fistula development but myths about witchcraft and fear of delivery were present. Nearly all women would recommend fistula repair to other women, and many were advocates in their communities.
Nearly all women believed their quality of life had improved at the individual and interpersonal levels since fistula repair, even among women who continued to have urinary incontinence. Contrary to other studies, women reported they were welcomed back by their communities and had limited challenges when reintegrating. Despite the overall improvements in quality of life, many continued to have relationship problems and were concerned about future fertility. These issues need to be further explored in other studies.
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