The Indian Practitioner

Abstract

Aim: To analyse trends of tubal sterilisations performed over a period of 30 years at the rural institute of eastern Maharashtra, in relation to age, parity or abortion. To analyse the change in the trend, if any and suggest any plan of action if necessary.

Methods: At our institute, women presenting for birth or abortion with previous one or more live children are advised and offered sterilisation. Records of women who had undergone sterilisation were analysed.

Results: The percentage of sterilisation in relation to over all births has decreased. It was 16.55% between 2002 - 2007 compared to 32.12% between 1977 - 1982. Proportion of sterilisation with caesarean section (C.S) has increased from 14.28% between 1977 - 1982 to 49.38% between 2002 - 2007. The rural urban ratio between 1977-1982 was 62:38 and between 2002 - 2007 also it was 62:38. Proportion of cases of less than 25 yrs of age has risen from 19.06% to 30.01% (p value < 0.005). Proportion of women undergoing sterilisation after 2 children has increased from 30% to 50% (p value < 0.05).

Summary and Conclusion: Positive sign is women with lower parity are getting sterilised at younger age. Cases of sterilisation along with Caesarean Section have increased and cases with abortions have decreased.

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Health providers need to know disease burden of communities they serve and the communities' health seeking behaviour and practices.

The study was conducted in 28 villages in eastern part of Maharashtra, India. Diary approach was used by middle school educated couples to collect information about sicknesses over a period and action taken by people. The study participants were 16895 men, women and children in the villages who permitted collection of information. All 1050 husbands and 649 wives recorded information. Overall 1699 people had 2685 episodes of sicknesses (1.58 episodes per person) and health care was taken by 1194 (70.27%) of 1699 for 1704 episodes (63.46%) of sicknesses. Skin disorders were most common but only 23.6% sufferers sought help, 90.5% people with dental problems took action like treatment with clove oil, camphor. Cough cold was mostly treated by ginger paste with honey, cloves, etc. by 30%.

Many villagers do not take action for many sicknesses. Home remedies safe/unsafe are commonly used. There is need of awareness, advocacy and behaviour change for utility of health care system which has to be proactive. Diary approach is useful for collecting information about the sickness burden and action taken by villagers. More research is essential.

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Present status: Uterine rupture could be complete or incomplete (inner layers torn but outer intact, or outer layer with part of myometrium torn but not extending into inner layer). Frequency in the developed countries was decreased because of availability, utilisation of quality care, but recent reports reveal increase, may be due to more interventions/more caesarean births. So there is renewed interest. Rupture could occur spontaneously during pregnancy in a weakened uterus of multiparity or previous caesarean section or other surgery or accident or intrauterine, manipulations. During labour it could be spontaneous, either because of obstruction due to contracted, deformed pelvis, malpresentations, multiple pregnancy, macrosomia, foetal anomalies, oxytocics, PCS, other surgery or perforation or trauma or previous uterine rupture or uterine anomaly. Diagnosis is delayed, unless possibility of rupture is kept in mind, because prior to circulatory collapse, signs, symptoms, may appear bizarre. Classic signs, sudden tearing pain, vaginal bleeding, cessation of contractions, regression of foetus are frequently absent. Non reassuring foetal heart rate may be indicative of imminent rupture. Thorough history/clinical examination are enough for diagnosis. Ultrasound shows abnormal foetal position/haemoperitoneum. Fatal exsanguination may supervene if broad ligament haematoma of incomplete rupture gives way relieving tamponading effect. Hypofibrinogenaemia may lead to complications. Therapy is general, depending on condition of patient, followed by laparotomy repair of rupture with or without tubectomy or hysterectomy depending on age, parity, patient's condition, rupture site, skill of surgeon.

Conclusion: It is essential to try prevention of rupture uterus, a catastrophic event by appropriate timely prenatal, intranatal evidence based care. If it occurs the mission has to be quality survival.

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Background: Use of health services depends on availability, accessibility, affordability as well as on social, personal characteristics and health beliefs of users, specially rural women. A very important factor is quality of services perceived by users, their satisfaction and dissatisfaction.

Objectives: Objectives of study were to know satisfaction, dissatisfaction of women seeking antenatal services with, plans to try change for best of satisfaction in given circumstances and share information.

Material Methods: One thousand pregnant women were interviewed randomly with predesigned questionnaire in local language by the social worker assigned the job, 5 - 6 per day one after other woman depending upon women's willingness and respecting their time.

Results: Interns had measured blood pressure of 970 (97%), 3% pregnant women's blood pressure was not recorded at referral health facility. Overall 910 (91%) women said complete checkup was done in the same visit, but 90 (9%) did not get check up completed. When they were asked about satisfaction, 850 (85%) said, yes, but 150(15%) were not satisfied. The reasons given were, procedure was time consuming and they were not told about results of check up satisfactorily.

Conclusion: It is essential to ensure that prenatal care is provided to the best of satisfaction of women.

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Abstract

Background: Use of health services depends on availability, accessibility, affordability as well as on social, personal characteristics and health beliefs of users, specially rural women. A very important factor is quality of services perceived by users, their satisfaction and dissatisfaction.

Objectives: Objectives of study were to know satisfaction, dissatisfaction of women seeking antenatal services with plans to try change for best of satisfaction in given circumstances and share information.

Material Methods: One thousand pregnant women were interviewed randomly with predesigned questionnaire in local language by the social worker assigned the job, 5 - 6 per day one after other woman depending upon women's willingness and respecting their time.

Results: Interns had measured blood pressure of 970 (97 %), 3% pregnant women's blood pressure was not recorded at referral health facility. Overall 910 (91 %) women said complete checkup was done in the same visit, but 90 (9 %) did not get check up completed. When they were asked about satisfaction, 850 (85%) said, yes, but 150(15 %) were not satisfied. The reasons given were, procedure was time consuming and they were not told about results of check up satisfactorily.

Conclusion: It is essential to ensure that prenatal care is provided to the best of satisfaction of women.

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