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O433 Village savings and loans associations – an innovative community financing approach for safe motherhood
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
92% (12/13). A small thymus showed high sensitivity and specificity (91% and 100%) for histological sings of inflammation. Conclusion: We therefore conclude that a normal sized thymus might be useful in ruling out latent intrauterine infection. Moreover, our findings also suggest that small transversal thymic diameter is associated with acute inflammatory changes in all placental tissue samples, and not only with chorioamnionitis and funisitis. This work was supported by grant from Czech Science Foundation No. 304–09–0494). O432 Community perception of safe motherhood in Kiboga and Kibaale Districts, Uganda: A qualitative study J. Rujumba1 , F. Kaharuza2 , O. Kakaire2 , J. Beyeza2 . 1 Department of Peadiatrics and Child Health Makerere University, 2 Association of Obstetricians and Gynaecologists of Uganda Objective: To establish perceptions and beliefs on pregnancy companion, birth preparedness, emergency preparedness, and factors affecting pregnancy and its management in rural Uganda. Methods: We conducted qualitative study in 6 communities served by 6 health units in Kibaale and Kiboga districts. Twelve focus group discussions, 27 key informant interviews and 4 in-depth interviews with women who delivered in different settings. Content analysis was done manually and common themes identified. Results: Most women regularly attend ANC but are motivated to get an ANC card to present at health facilities in emergencies. Pregnancy is not perceived as a risk, thus mothers don’t plan for emergency care. TBAs are preferred over health workers because they are perceived as experienced, inexpensive, kind and caring. Health workers are perceived as rude, uncaring, young and inexperienced. Some communities in Kibaale believed in using supernatural healing water during labor. Men perceived pregnancy and childbirth as feminine domain and their role was limited to providing money for transport and buying drugs. Health facility gaps – shortages of staff, drugs and supplies; require mothers to provide supplies used at delivery. Lack of a functional referral system and past positive home delivery experience with TBAs discouraged mothers from delivering at health facilities. Conclusions: Community perceptions and health facility gaps limit access to appropriate maternal health services. Potential community interventions considering a pregnancy companion, emergency preparedness, facility-TBA partnerships and comprehensive behavioral communication interventions are required for appropriate maternal health services. O433 Village savings and loans associations – an innovative community financing approach for safe motherhood J. Beyeza-Kashesya, A. Mugasa, F. Kaharuza. Makerere College of Health Sciences Objective: To establish emergency financing for safe motherhood at community level to reduce the delays to access emergency obstetric care (EMOC) using the village savings and loans associations (VSLA) system of income generation. Methods: Community Based Safe motherhood Promoters were identified and provided with targeted training and basic literature on VSLA. These were in turn to provide training and support to groups at community. Two trainings were done for 18 local people in two sub counties. Training was done using the CARE Uganda VSLA training manual but modified to include a saving for safe motherhood component. Supervision to support the local trainers in their villages, training materials, and provision of emergency preparedness information and a non-interest revolving fund for emergency treatment was done by AOGU team. Results: The 18 local trainers at community level trained community members whose finance generation skills increased. The ability of communities to respond to obstetric and newborn
complications, and capacity of women to access maternal and newborn health services increased. A follow up at two months found that the first 6 trainers had formed and trained 18 groups totaling to 434 people from one sub-county. The 6 groups had generated 2,000,000Ushs, one third of which was for the emergency fund. Two thirds could be loaned at an interest for income generation activities. Conclusion: Increased knowledge in financial generation and saving skills in the community as evidenced by the accumulating revenues over time would aid communities to respond to obstetric and newborn complications, and access maternal and newborn health services. O434 Potential human papillomavirus (HPV) screening test in Sichuan, China Y. Kaixuan, S. Liang, Y. Fan, H. Ying. Pathology Deparment, West China second university hospital Objective: We tested the feasibility of introducing HPV test for cervical cancer screening, to exploit its high sensitivity while avoiding its low predictive value for cancer and precancer. Methods: Nested polymerase chain reaction (PCR) products of the L1 gene region were subjected to direct DNA sequencing for determination of the HPV genotype by signature DNA sequence algorithm against the Genbank database. Results: Of the 191 samples with a reactive-changes cytology selected for PCR amplification, 16 (8.3%) were found to be positive for high-risk HPV DNA. Of the 11 samples with atypical squamous cells of undetermined significance, 3 (27%) were positive for highrisk HPV. Conclusion: DNA sequencing may be a useful tool to increase the specificity of HPV genotyping for following high-risk persistent HPV infections to reduce excessive colposcopic procedures in low cancer prevalence populations. However, one-occasion positive HPV test results are of limited use as a screening test for triage referral to colposcopy in developing regions. O435 External clinical pelvimetry and pregnancy outcome: Preliminary results of a longitudinal survey in nulliparae in the southern province of Rwanda (Huye district) J. Kakoma Zambeze, J. Kalibushi, K. Ramazani. 1 National University of Rwanda, Obs & Gyne Department Introduction and Objective: Some anthropometric and pelvic parameters (height and external pelvic diameters) have been associated to primary and elective repeat cesarean section in African women. Although external pelvimetry has been debatable since many years, the authors wanted, apart from height, to experience the ability of external clinical pelvimetry to predict success for vaginal birth in a resource-limited country (Rwanda). Methodology: This forecast, longitudinal, and analytical study concerns two groups of pregnant women randomly selected in 7 health centers depending on Kabutare District Hospital and University Teaching Hospital-Butare (Southern Province of Rwanda): a study group (152 nulliparae who gave birth among all those who were involved in a broad survey on pelvimetry) and controls (314 multiparae without previous cesarean section, and thus clinically presenting a practicable pelvis). Height, external pelvic diameters, and the Base of the Trillat’s Triangle were respectively evaluated using a sliding ruler on a scale, Martin’s and Breisky’s pelvimeters, and a ribbon measure. Delivery was a doubleblind trial (for investigators and attendants). Chi square (with Yates’ correction) and Fisher’s exact tests were used to compare observed proportions, and Student’s t test to compare mean values from normally distributed populations. Results: Cesarean sections (CS) rate was 21.05% in nulliparae. The average height was smaller in nulliparae with CS
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
92% (12/13). A small thymus showed high sensitivity and specificity (91% and 100%) for histological sings of inflammation. Conclusion: We therefore conclude that a normal sized thymus might be useful in ruling out latent intrauterine infection. Moreover, our findings also suggest that small transversal thymic diameter is associated with acute inflammatory changes in all placental tissue samples, and not only with chorioamnionitis and funisitis. This work was supported by grant from Czech Science Foundation No. 304–09–0494). O432 Community perception of safe motherhood in Kiboga and Kibaale Districts, Uganda: A qualitative study J. Rujumba1 , F. Kaharuza2 , O. Kakaire2 , J. Beyeza2 . 1 Department of Peadiatrics and Child Health Makerere University, 2 Association of Obstetricians and Gynaecologists of Uganda Objective: To establish perceptions and beliefs on pregnancy companion, birth preparedness, emergency preparedness, and factors affecting pregnancy and its management in rural Uganda. Methods: We conducted qualitative study in 6 communities served by 6 health units in Kibaale and Kiboga districts. Twelve focus group discussions, 27 key informant interviews and 4 in-depth interviews with women who delivered in different settings. Content analysis was done manually and common themes identified. Results: Most women regularly attend ANC but are motivated to get an ANC card to present at health facilities in emergencies. Pregnancy is not perceived as a risk, thus mothers don’t plan for emergency care. TBAs are preferred over health workers because they are perceived as experienced, inexpensive, kind and caring. Health workers are perceived as rude, uncaring, young and inexperienced. Some communities in Kibaale believed in using supernatural healing water during labor. Men perceived pregnancy and childbirth as feminine domain and their role was limited to providing money for transport and buying drugs. Health facility gaps – shortages of staff, drugs and supplies; require mothers to provide supplies used at delivery. Lack of a functional referral system and past positive home delivery experience with TBAs discouraged mothers from delivering at health facilities. Conclusions: Community perceptions and health facility gaps limit access to appropriate maternal health services. Potential community interventions considering a pregnancy companion, emergency preparedness, facility-TBA partnerships and comprehensive behavioral communication interventions are required for appropriate maternal health services. O433 Village savings and loans associations – an innovative community financing approach for safe motherhood J. Beyeza-Kashesya, A. Mugasa, F. Kaharuza. Makerere College of Health Sciences Objective: To establish emergency financing for safe motherhood at community level to reduce the delays to access emergency obstetric care (EMOC) using the village savings and loans associations (VSLA) system of income generation. Methods: Community Based Safe motherhood Promoters were identified and provided with targeted training and basic literature on VSLA. These were in turn to provide training and support to groups at community. Two trainings were done for 18 local people in two sub counties. Training was done using the CARE Uganda VSLA training manual but modified to include a saving for safe motherhood component. Supervision to support the local trainers in their villages, training materials, and provision of emergency preparedness information and a non-interest revolving fund for emergency treatment was done by AOGU team. Results: The 18 local trainers at community level trained community members whose finance generation skills increased. The ability of communities to respond to obstetric and newborn
complications, and capacity of women to access maternal and newborn health services increased. A follow up at two months found that the first 6 trainers had formed and trained 18 groups totaling to 434 people from one sub-county. The 6 groups had generated 2,000,000Ushs, one third of which was for the emergency fund. Two thirds could be loaned at an interest for income generation activities. Conclusion: Increased knowledge in financial generation and saving skills in the community as evidenced by the accumulating revenues over time would aid communities to respond to obstetric and newborn complications, and access maternal and newborn health services. O434 Potential human papillomavirus (HPV) screening test in Sichuan, China Y. Kaixuan, S. Liang, Y. Fan, H. Ying. Pathology Deparment, West China second university hospital Objective: We tested the feasibility of introducing HPV test for cervical cancer screening, to exploit its high sensitivity while avoiding its low predictive value for cancer and precancer. Methods: Nested polymerase chain reaction (PCR) products of the L1 gene region were subjected to direct DNA sequencing for determination of the HPV genotype by signature DNA sequence algorithm against the Genbank database. Results: Of the 191 samples with a reactive-changes cytology selected for PCR amplification, 16 (8.3%) were found to be positive for high-risk HPV DNA. Of the 11 samples with atypical squamous cells of undetermined significance, 3 (27%) were positive for highrisk HPV. Conclusion: DNA sequencing may be a useful tool to increase the specificity of HPV genotyping for following high-risk persistent HPV infections to reduce excessive colposcopic procedures in low cancer prevalence populations. However, one-occasion positive HPV test results are of limited use as a screening test for triage referral to colposcopy in developing regions. O435 External clinical pelvimetry and pregnancy outcome: Preliminary results of a longitudinal survey in nulliparae in the southern province of Rwanda (Huye district) J. Kakoma Zambeze, J. Kalibushi, K. Ramazani. 1 National University of Rwanda, Obs & Gyne Department Introduction and Objective: Some anthropometric and pelvic parameters (height and external pelvic diameters) have been associated to primary and elective repeat cesarean section in African women. Although external pelvimetry has been debatable since many years, the authors wanted, apart from height, to experience the ability of external clinical pelvimetry to predict success for vaginal birth in a resource-limited country (Rwanda). Methodology: This forecast, longitudinal, and analytical study concerns two groups of pregnant women randomly selected in 7 health centers depending on Kabutare District Hospital and University Teaching Hospital-Butare (Southern Province of Rwanda): a study group (152 nulliparae who gave birth among all those who were involved in a broad survey on pelvimetry) and controls (314 multiparae without previous cesarean section, and thus clinically presenting a practicable pelvis). Height, external pelvic diameters, and the Base of the Trillat’s Triangle were respectively evaluated using a sliding ruler on a scale, Martin’s and Breisky’s pelvimeters, and a ribbon measure. Delivery was a doubleblind trial (for investigators and attendants). Chi square (with Yates’ correction) and Fisher’s exact tests were used to compare observed proportions, and Student’s t test to compare mean values from normally distributed populations. Results: Cesarean sections (CS) rate was 21.05% in nulliparae. The average height was smaller in nulliparae with CS