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I371 “TOO MUCH FANTASY”
Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
I369 EXPANDING THE USE OF MAGNESIUM SULPHATE IN NIGERIA J. Tukur1 , A. Babatunde2 , I. Salisu2 , O. Babatunde Ayodeji2 . 1 Bayero University, Kano, Nigeria; 2 Population Council, Abuja, Nigeria Background: Magnesium Sulphate (MgSo4) is the drug of choice for the treatment of severe Preeclampsia and eclampsia (SPE/E). Despite the evidence on its effectiveness, it is not universally used in Nigeria. Intervention: Population Council, with support from MacArthur Foundation, has been implementing projects to expand the use of MgSo4 in Nigeria. Interventions were done at policy level, at health system level, and the service delivery level. Policy advocacy set the stage for adopting MgSo4 as a treatment/management option for PE/E, accompanied by development of service delivery protocols, and introduction of this new practice at primary and secondary health facilities Results: Within 12 months of introducing the drug in 10 secondary health facilities in Kano, 49 patients with severe pre-eclampsia and 996 patients with eclampsia were treated. This led to a reduction in case fatality from 21% to 2% facilitating the institutionalization of MgSo4 across the state, so that from the initial 10 hospitals, the project expanded to 35 hospitals within a year. Trained lower cadre health workers working at PHCs were able to safely administer MgSO4 with demonstrable benefits on maternal and fetal outcomes. Council’s partnership with the Federal Ministry of Health has also resulted in the development of a unified national training curriculum on eclampsia and use of MgSo4. Efforts are on-going with the national council of health, national council of nursing and midwifery and community health practitioners’ registration board to ensure a national scale up for the administration of the drug at PHCs. Conclusion: Expanding the use of MgSo4 requires engagement of stakeholders, training and supervision of health workers, and availability of the drug at affordable rates. These replicable interventions can substantially reduce maternal and perinatal mortality due to SPE/E in Nigeria. I370 THE USE OF MVA FOR ABORTION CARE IN SELECTED HEALTH INSTITUTIONS IN YAOUNDE, CAMEROON F. Tumasang. Former President of the Cameroon Medical Women’s Association (CMWA), Secretary General of the Society for women and AIDS in Africa (SWAA), Member of the Society of Gynaecologists and Obstetricians (SOGOC) Overview: The maternal mortality rate in Cameroon is 669 per 100,000 live births. Up to 30% of cases are abortion related. Abortion is legally permitted only in cases of rape or risk to the mother’s health. Objective: To determine the availability and usage of MVA equipment in Yaounde, ´ capital of Cameroon. Method: Prospective study in which gynecologists, residents and some nurse/midwives taking care of patients who came in with incomplete or missed abortion were interviewed. Four referral/ teaching hospitals, one non-teaching tertiary hospital and two district hospitals in the town of Yaounde were included in the study. Results: Two of the tertiary hospitals have no MVA equipment at all. One teaching hospital has MVA available only during working hours. One of the district hospitals has MVA available 24hours. In another the MVA is kept in the hospitals director’s office and is only available when he is present. More than 70% of providers prefer MVA for the treatment of abortions, but have no access to it. The rest of the providers have never been trained in the use of MVA or are uncomfortable with it. Conclusion: Most of the providers in Yaounde prefer to use the MVA for the treatment of incomplete abortions, but MVA is not available or available only during working hours. Some of the providers have not had training in the use of MVAs. Training in the
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use of and provision of MVA will help in improving post abortion care and reducing maternal mortality. I371 “TOO MUCH FANTASY” A.D. Turchetto. Ginecologa Psicoterapeuta, Venezia, Italy Little is known about pre adolescent and very young teens sexuality. It’s a hard job to gather enough and reliable data on this items. The main sources are, of course, face to face interview, anonymous questionnaire and internet self administrated questions. We often encounter many resistances in coping the adolescent’s families and obtaining their allow for a deep and free interview. A valid way to get information dealing with the youngest is the wide spread methodology utilized by the Adolescent consultant centres to perform their “Sexual Educations” in the lower grade schools. They collect the permission from the families to answer at ANY question that the pupils could anonymously write and put in a sealed box. We are no more appalled to cope with the sketch of the very young girls and boys (from 10 to 14) that these questions may suggest. The real world and the real needs now begins to be well known, even if not yet we are prepared to manage with. This is from a phenomenological up-side down point of view. Fixing some topics of the pre adolescent and very young teens we need to know more about there are: • The very impossible mission of enhancing the Double Dutch protection. • Harder and harder to obtain a good self protection if the girl is a weak negotiator, lacking of self esteem and assertiveness • The hard job of the dating with their own sexuality among people that has subdue or assisted to violence or abuse in childhood. • Their way to getting “to the point”, freely or compelled, sharing good feelings or nullified by their own weakness or and loneliness The compass for this hard sailing can be provide by the teen Consultant Adolescent Services: what they offer and how they act. We have to know something more about the unknown world of the illegal abortion, absolutely destructive for the youngest. Less unknown but either not so much dealt with are the long and winding roads that the sexual activity among very young teens. They think to know all but they know nothing. Actually anal intercourse (coitus analis), cunnilingus and fellatio are largely employed as much safer way for intercourses, surely toward pregnancy, but absolutely not toward MST. I372 WOMEN’S CHOICES AND HUMAN RIGHTS E. Valerio Castro Can a pregnancy constitute an injury when many women choose that very event? Why don’t women seek an abortion if the consequences of pregnancy are seen as harmful? The concept of autonomy, though an important value for promoting women’s reproductive freedom, is transforming into reproductive expectation. Scientific and clinical advances, social and political developments and the impact of healthcare on our lives raised profound ethical and legal questions. Medical law and ethics have become central to our understanding of these problems, and are important tools for the analysis and resolution of problems – real or imagined. In case of a wrongful birth, the negligence may have involved the failure to diagnose a pregnancy, or the failure to diagnose or inform of the risk, that if born, the child would suffer from serious disability. These can be viewed as the products of medical progress and increased choice in the field of reproduction. Normal expectation of life may incluye to avoid parenthood when conditions are not right. Although choice is a term inclined to mislead, it is nevertheless important to take seriously a woman’s
I369 EXPANDING THE USE OF MAGNESIUM SULPHATE IN NIGERIA J. Tukur1 , A. Babatunde2 , I. Salisu2 , O. Babatunde Ayodeji2 . 1 Bayero University, Kano, Nigeria; 2 Population Council, Abuja, Nigeria Background: Magnesium Sulphate (MgSo4) is the drug of choice for the treatment of severe Preeclampsia and eclampsia (SPE/E). Despite the evidence on its effectiveness, it is not universally used in Nigeria. Intervention: Population Council, with support from MacArthur Foundation, has been implementing projects to expand the use of MgSo4 in Nigeria. Interventions were done at policy level, at health system level, and the service delivery level. Policy advocacy set the stage for adopting MgSo4 as a treatment/management option for PE/E, accompanied by development of service delivery protocols, and introduction of this new practice at primary and secondary health facilities Results: Within 12 months of introducing the drug in 10 secondary health facilities in Kano, 49 patients with severe pre-eclampsia and 996 patients with eclampsia were treated. This led to a reduction in case fatality from 21% to 2% facilitating the institutionalization of MgSo4 across the state, so that from the initial 10 hospitals, the project expanded to 35 hospitals within a year. Trained lower cadre health workers working at PHCs were able to safely administer MgSO4 with demonstrable benefits on maternal and fetal outcomes. Council’s partnership with the Federal Ministry of Health has also resulted in the development of a unified national training curriculum on eclampsia and use of MgSo4. Efforts are on-going with the national council of health, national council of nursing and midwifery and community health practitioners’ registration board to ensure a national scale up for the administration of the drug at PHCs. Conclusion: Expanding the use of MgSo4 requires engagement of stakeholders, training and supervision of health workers, and availability of the drug at affordable rates. These replicable interventions can substantially reduce maternal and perinatal mortality due to SPE/E in Nigeria. I370 THE USE OF MVA FOR ABORTION CARE IN SELECTED HEALTH INSTITUTIONS IN YAOUNDE, CAMEROON F. Tumasang. Former President of the Cameroon Medical Women’s Association (CMWA), Secretary General of the Society for women and AIDS in Africa (SWAA), Member of the Society of Gynaecologists and Obstetricians (SOGOC) Overview: The maternal mortality rate in Cameroon is 669 per 100,000 live births. Up to 30% of cases are abortion related. Abortion is legally permitted only in cases of rape or risk to the mother’s health. Objective: To determine the availability and usage of MVA equipment in Yaounde, ´ capital of Cameroon. Method: Prospective study in which gynecologists, residents and some nurse/midwives taking care of patients who came in with incomplete or missed abortion were interviewed. Four referral/ teaching hospitals, one non-teaching tertiary hospital and two district hospitals in the town of Yaounde were included in the study. Results: Two of the tertiary hospitals have no MVA equipment at all. One teaching hospital has MVA available only during working hours. One of the district hospitals has MVA available 24hours. In another the MVA is kept in the hospitals director’s office and is only available when he is present. More than 70% of providers prefer MVA for the treatment of abortions, but have no access to it. The rest of the providers have never been trained in the use of MVA or are uncomfortable with it. Conclusion: Most of the providers in Yaounde prefer to use the MVA for the treatment of incomplete abortions, but MVA is not available or available only during working hours. Some of the providers have not had training in the use of MVAs. Training in the
S253
use of and provision of MVA will help in improving post abortion care and reducing maternal mortality. I371 “TOO MUCH FANTASY” A.D. Turchetto. Ginecologa Psicoterapeuta, Venezia, Italy Little is known about pre adolescent and very young teens sexuality. It’s a hard job to gather enough and reliable data on this items. The main sources are, of course, face to face interview, anonymous questionnaire and internet self administrated questions. We often encounter many resistances in coping the adolescent’s families and obtaining their allow for a deep and free interview. A valid way to get information dealing with the youngest is the wide spread methodology utilized by the Adolescent consultant centres to perform their “Sexual Educations” in the lower grade schools. They collect the permission from the families to answer at ANY question that the pupils could anonymously write and put in a sealed box. We are no more appalled to cope with the sketch of the very young girls and boys (from 10 to 14) that these questions may suggest. The real world and the real needs now begins to be well known, even if not yet we are prepared to manage with. This is from a phenomenological up-side down point of view. Fixing some topics of the pre adolescent and very young teens we need to know more about there are: • The very impossible mission of enhancing the Double Dutch protection. • Harder and harder to obtain a good self protection if the girl is a weak negotiator, lacking of self esteem and assertiveness • The hard job of the dating with their own sexuality among people that has subdue or assisted to violence or abuse in childhood. • Their way to getting “to the point”, freely or compelled, sharing good feelings or nullified by their own weakness or and loneliness The compass for this hard sailing can be provide by the teen Consultant Adolescent Services: what they offer and how they act. We have to know something more about the unknown world of the illegal abortion, absolutely destructive for the youngest. Less unknown but either not so much dealt with are the long and winding roads that the sexual activity among very young teens. They think to know all but they know nothing. Actually anal intercourse (coitus analis), cunnilingus and fellatio are largely employed as much safer way for intercourses, surely toward pregnancy, but absolutely not toward MST. I372 WOMEN’S CHOICES AND HUMAN RIGHTS E. Valerio Castro Can a pregnancy constitute an injury when many women choose that very event? Why don’t women seek an abortion if the consequences of pregnancy are seen as harmful? The concept of autonomy, though an important value for promoting women’s reproductive freedom, is transforming into reproductive expectation. Scientific and clinical advances, social and political developments and the impact of healthcare on our lives raised profound ethical and legal questions. Medical law and ethics have become central to our understanding of these problems, and are important tools for the analysis and resolution of problems – real or imagined. In case of a wrongful birth, the negligence may have involved the failure to diagnose a pregnancy, or the failure to diagnose or inform of the risk, that if born, the child would suffer from serious disability. These can be viewed as the products of medical progress and increased choice in the field of reproduction. Normal expectation of life may incluye to avoid parenthood when conditions are not right. Although choice is a term inclined to mislead, it is nevertheless important to take seriously a woman’s