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Reproductive health

Reproductive health. Over 25000 women and girls die each year More than 500,000 Ethiopian women and girls suffer from disabilities 0.3% of all deliveries (8000-9000) develop obstetric fistula . Obstetric Fistula.

Thomas
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Reproductive health

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  1. Reproductive health Over 25000 women and girls die each year More than 500,000 Ethiopian women and girls suffer from disabilities 0.3% of all deliveries (8000-9000) develop obstetric fistula

  2. Obstetric Fistula It is a hole that forms in the vaginal wall communicating with the bladder (Vesico-Vaginal Fistula) or the rectum (Recto-Vaginal Fistula) or both, as a result of obstructed labour, beyond the reach of medical help.

  3. Usual features of fistula patients:- • Young peasant girls • Married in their early teens • Given heavy tasks in the household • Not having an access to any health institution during labor (long distance, no transportation) • Labor prolonged and obstructed (average 3.8 days, range 1-10) • These young women often helped by women of the village • Baby dies in uterus • Head collapses and dead baby is expelled

  4. Usual features of fistula patients:- • Few days latter a new horror wakes them up- incontinence • Often whishes they died with the baby, many commit suicide • Soon deserted by their husbands, ostracized by their village friends, excluded from their old social life • They exist without friends, without hope, bearing their sorrow and suffering in silent shame

  5. Patient distribution by region • Amhara 39.7% • Oromo 28% • Southern 17% • Tigray 6.4% • Harar 0.6% • Benshangul 0.3% • Somalia 0.3% • Others 4.0% • AA 2.0% • No information 1.2%

  6. Age profile • <16 5% • 16-20 38.4% • 21-25 23.6% • 26-30 16.5% • 31-35 8.1% • 36-40 5.8% • 41-45 1.3% • >45 1.2%

  7. The Addis Ababa Fistula Hospital • The second fistula hospital; Founded in 1974 • A free charitable hospital • Operated more than 25000 patients • Operates 1200-1300 patients/year • Trains doctors • On the process to establish 5 outreach centers • Six gynecologists

  8. The Addis Ababa Fistula Hospital • 12 nurses and more than 40 nurse aids • A village for fistula patients with conduits • Have school and physiotherapy department where they exercise for the crippling injuries

  9. Cause of Fistula Obstructed labor Obstructed transport Reginald Hamlin

  10. PROBLEM AREAS A- Problems directly related to the three delays: Delay in decision making Delay in transportation to health institution Delay of care in health institution B- Other socio-cultural problems (contributing factors)

  11. Delay in decision making -Low status of women (Low involvement of women as decision makers) -Illiteracy -Inhibitory socio-cultural practices -poverty -poor information on health issues (both to men and women

  12. Delay in transportation to health institution -Distance Poor roads Transportation system, not existing -No means of communication -Poor referral system -Poverty

  13. Accessing EMOC was difficult, because:- • Distance 28.2 • Economy 13.6 • Poor knowledge 9.8 • Referral 4.7 • Distance and economy 23 • Poor knowledge +Economy 11.3 • Poor know +distance 2.3

  14. Accessing EMOC was difficult, because:- cont • Dista+ economy+ poor know 5.2 • Referral +poor knowledge 0.9 • Referral + economy 0.5 • Referral +distance 0.5 • Total 100

  15. Delay of care in health institutions -Financial accountability (resources, supplies, etc) -Health staff motivation (lack of commitment, urbanization, etc) -Managerial accountability (Budgets underutilized) -Manpower inadequate - Restrictive laws

  16. Other factors • -Illiteracy • -Harmful traditions • -Poor access to other reproductive health care services

  17. Interventions • Access to information • Access to EMOC • Quality EMOC

  18. Access to information • School enrolment • Community education • IEC/BC

  19. Access to EMOC • Road • Transport • Communication (link) • Affordability “Those mothers who failed to access road to EMOC will easily access road to death or disability’’.

  20. Quality EMOC • Capacity building -training -equipments and supplies • sustainability • Affordability/free of charge

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