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Reproductive health
Over 25000 women and girls die each year More than 500,000 Ethiopian women and girls suffer from disabilities0.3% of all deliveries (8000-9000) develop obstetric fistula
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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.
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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
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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
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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%
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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%
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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
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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
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Cause of Fistula
Obstructed laborObstructed transport Reginald Hamlin
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PROBLEM AREAS
A- Problems directly related to the three delays:Delay in decision makingDelay in transportation to health institutionDelay of care in health institutionB- Other socio-cultural problems (contributing
factors)
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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
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Delay in transportation to health institution
-Distance-Poor roads -Transportation system, not existing-No means of communication -Poor referral system -Poverty
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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
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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
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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
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Other factors
-Illiteracy -Harmful traditions -Poor access to other reproductive
health care services
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Interventions
Access to information Access to EMOC Quality EMOC
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Access to information
School enrolment Community education IEC/BC
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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’’.
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Quality EMOC
Capacity building
-training
-equipments and supplies sustainability Affordability/free of charge
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