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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.

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Reproductive health


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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

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.

usual features of fistula patients
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
usual features of fistula patients5
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
patient distribution by region
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%
age profile
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%
the addis ababa fistula hospital
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
the addis ababa fistula hospital12
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
cause of fistula

Cause of Fistula

Obstructed labor

Obstructed transport

Reginald Hamlin

problem areas

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)

delay in decision making

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

delay in transportation to health institution

Delay in transportation to health institution

-Distance

Poor roads

Transportation system, not existing

-No means of communication

-Poor referral system

-Poverty

accessing emoc was difficult because
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
accessing emoc was difficult because cont
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
delay of care in health institutions

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

other factors
Other factors
  • -Illiteracy
  • -Harmful traditions
  • -Poor access to other reproductive health care services
interventions
Interventions
  • Access to information
  • Access to EMOC
  • Quality EMOC
access to information
Access to information
  • School enrolment
  • Community education
  • IEC/BC
access to emoc
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’’.

quality emoc
Quality EMOC
  • Capacity building

-training

-equipments and supplies

  • sustainability
  • Affordability/free of charge