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METHODOLOGY

CHAPTER THREE: METHODOLOGY

Methodology is the longest and most examinable, take note.

3.1 Introduction
3.2 Study Design and rationale
3.3 Study setting and rationale
3.4 Study Population
3.4.1 Sample Size Determination
3.4.2 Sampling Procedure
3.4.3 Inclusion Criteria
3.5 Definition of Variables
3.6 Research Instruments
3.7 Data collection Procedure
3.7.1 Data management
3.7.2 Data analysis
3.8 Ethical Consideration
3.9 Limitations of the study
3.10 Dissemination of Results

Methodology therefore consists or covers the methods the researcher is to follow while carrying out research. Therefore it includes the following.

Introduction.
Study Design.
Study Setting.
Study Population.
Sample Size. Determination.
- Diploma level studies should have a minimum of 30 participants.
- Student should give justification for selected sample size.
Sampling Procedure.

Inclusion Criteria.
Definitions of Variables.
Research Instruments.
Data Collection Procedures.
Data Management.
Data Analysis.
Protection of Human Subjects.
Dissemination of Results.
Limitations of the Study.

3.2 Study Design

Study or Research design defines the approaches, methods and the rationale of picking that appropriate research design

Eg descriptive cross sectional design
Approaches can be Quantitative/qualitative or both
Note that it is advisable to use one of these at our level.

The design is the structure of the study. This is the framework for the methodology to be applied while collecting data, sampling, analyzing data, etc.

The function of a study or research design is to ensure that the evidence obtained enables us to answer the initial question as unambiguously as possible. In other words, when designing research we need to ask: 1. Given this research question/problem, what type of evidence is needed to answer the question in convincing way?
You should always state the reason/rationale for using that particular design (why that particular design).

Example: “The study will use a retrospective comparative study design and this is due to the fact that it involves comparing virological outcomes in 4 different groups of patients on different arms of first-line ART regimens. The study will also employ a quantitative method of data collection in order to quantify the most efficacious
1st– line ART regimen in terms of virological suppression”

3.3 Study Setting

Also called the study area.
It helps the reader to locate where your study is to be done from.
Direct the reader in terms of location (Where are you’re
going to do the study from?)
Why that setting? (State the rationale for using that
setting).

Example: “Study will be carried out at ART clinic of Kayunga Hospital in Kayunga district which is located in central part of Uganda. ART clinic operates on daily basis from Monday to Friday from 8am to 4pm. It has a total of 10 nurses, 2 laboratory technicians, 2 clinical officers and I medical officer. This clinic receives on average a number of 150 patients on every clinic day. The study setting was chosen because ART clinic serves a big population of about 4500 HIV/AIDS infected people”.

3.4 Study Population

Explain the population from which your sample will be collected from.
This is the population that the results will be generalised to.
Give the rationale for the selected population.

Population: This is the total of items or events in a set; with relevant characteristics that a researcher need (It is the total number of potential subjects /respondents for a study).

The population should be clearly defined before a decision is taken on how to sample it.
• Sampling is not necessary if the population is small.

Example: “This study will be carried out among HIV-infected clients attending Kayunga ART clinic and who are on first-line ART regimens for at least three years. Kayunga ART clinic has a total of 4791 of which 2728 are on 1st line ART regimen. The clinic usually receives about 50 clients who are on 1st-line ART regimen per day and therefore a total of 250 clients on 1st-line ART will be available for Data collection within 5 days of data collection”.

3.4.1 Sample Size Determination

Sampling is the process of selecting a subset(sample) from a large group of people(population)
Steps in sampling
- Define the population
- Identify the sampling frame ie list of participants from which a sample can be selected
- Select a sampling procedure this could be probability or nonprobability sampling
- Determine the sample
- Draw the sample
- Give justification
State the standardized method you will use to estimate
the sample size.

For example: “Using Krejcie and Morgan (1970)’s table, when a population is-250, a total of sample size of 150 respondent is supposed to be sampled”

3.4.2 Sampling Procedure

This refers to the way you select your participants to include in your study.
It can be Probability or non probability sampling.
Probability sampling involves;
- Simple random sampling.
- Systemic sampling.
- Stratified sampling.
- Cluster sampling.
Non probability sampling involves;
- Convenience sampling.
- purposive/ judgemental sampling.
- Snowball sampling.
- Quota sampling.

Explain how the subjects will be selected during sampling.

For example, a proportionate quota sampling method will be used to sample representative clients on the different first -line ART regimens.

State the reason (rationale) why you have decided to use that particular procedure.

3.4.3 Inclusion Criteria

This gives a narration of which people among the selected population will qualify to participate in your study.
Those who do not qualify are the excluded from your study.

Inclusion criteria: are characteristics that the prospective subjects must have if they are to be included in the study.- Inclusion criteria may include factors such as age, sex, race, ethnicity, stage of disease, the subject’s past treatment history, E.T.C.

Example: “For participants to be included in this study, they have to be clients on 1st line-ART regimen for at least 3 years and are attending ART clinic at Kayunga Hospital during the time of data collection. They must also be of 18 years of age and above. Since 18 year of age is the consent age according to the Ugandan constitution”.

3.5 Definitions of Variables

A measurable characteristic that assumes different values among the subjects
It’s a value of interest to the researcher
Basically variables can be;
- Dependant
- Independent
- Intervening
Let the reader know what, (define), your dependent variable and independent variables of the study are.

For example; “the dependent variable of this study is the virological outcome (level of viral load). In this study the level of viral load means the amount (measure) of Plasma HIV-1 RNA. Viral load is measured in ml/copies. Viral load of >5000 copies/ml at 12 months of antiretroviral treatment will be taken as indication for virological failure (similar to WHO recommendation in resource- limited countries)”.

3.6 Research Instruments

This refers to the tools you are going to use to answer your objectives
They include;
- Questionnaires
- Interviews
- Checklists
- Standardized tests

Explain the instruments that will be used to collect data.
For, example: “The researcher will use a questionnaire which consists of both open and close ended questions written in simple language and will be filled by the researcher himself and his assistant by use of patient’s files and interview of clients. The questionnaire written by the researcher will be pretested to adjust for any ambiguity or errors and corrections will be made”.

Questionnaires: This mainly involves the use of pre-determined answers to gather information from participants

It mainly has two forms
- Self administered
- Researcher administered
Questions can be closed ended or open ended

Advantages and Disadvantages

	Self-Administered Questionnaires	Researcher-Administered Questionnaires
Advantages
Convenience	Participants can complete at their own pace.	Researchers can clarify questions for better understanding.
Privacy	Respondents have privacy for sensitive questions.	Higher motivation can lead to improved response rates.
Time Flexibility	Participants can choose when to complete the survey.	Allows probing to ensure thorough and accurate responses.
Cost-Effective	No researcher presence reduces data collection costs.	Researchers can control the survey environment.
Large Sample Size	Suitable for reaching a larger, geographically spread sample.	Offers control over data quality and completeness.
Reduced Researcher Bias	Participants may provide candid responses.	Offers the ability to probe and clarify ambiguous answers.
Disadvantages
Non-Response Bias	Response rates might be lower, potentially biased.	Time-consuming due to researcher presence.
Misinterpretation	Participants might misunderstand questions.	Presence of a researcher can influence participant responses.
Incomplete Responses	Respondents may skip or provide incomplete answers.	Can be costly due to resources needed for administration.
Low Control	Researchers have limited control over survey environment.	Limited anonymity might affect the honesty of responses.
Limited Probing	Researchers cannot probe further for clarification.	Geographical constraints limit participant availability.

Interviews: These are mainly used to get responses for qualitative data

They could be used as;
- Interview guides.
- Focus Group discussion interviews- of 5 to 10 members.

Checklists: Also called observation forms.

Researcher ticks responses on observation of what has been done or not.
In many studies rating is done there after.

Standardized tests:

These are tools used to score all populations across the board.
For example when scoring IQ levels of children, cognitive tests.

3.7 Data Collection Procedures

This involves the use of the selected tool/tools to gather information from the participants.
It explains how the selected data tool will collect the information.
These are selected depending on the design and approach selected.
Here, you explain the whole procedure of data collection.

For Example: “A letter obtained from research committee will be taken to the management of Kayunga Hospital and to the ART clinic to allow researcher carry out data collection among HIV- infected clients on 1st
line ART regimens. One clinician will be identified from ART clinic and will be trained as a research assistant to help in filling in the questionnaires. A verbal and written consent will be obtained from respondents before data collection and an appreciation in form of thanks will be told to clients.”

3.7.1 Data Management

This involves the cleaning of data to correct any missing errors.
It involves pre cleaning before actual data entry to eliminate wrong data entry.
Explain how data will be managed.

For, example: “After data collection, every questionnaire will be checked for completeness and any gaps will be filled immediately before the client leaves the clinic. The questionnaire will be kept under key and lock only accessible to the researcher and his assistant on request then it will directly be entered into SSPS soft ware package for social science version.”

3.7.2 Data Analysis

After data has been cleaned, it then analyzed and interpreted to make meaningful statements.
This is then followed by making interpretation of findings before the actual generalization of the research findings.
Explain how data will be analyzed.

For example, “Data will be entered directly into SPSS 17 for data analysis and will be analyzed starting with the demographic data and then the other objectives. The Analyzed data will then be presented in form of percentages and frequencies in tables, pie charts, and graphs”.

3.8 Ethical considerations

This looks at the ethics of your research(Protection of Human Subjects)
- Informed consent
- Confidentiality
- Ethics committees
- Privacy
Explain how you will meet the ethical guidelines of research.

For example: “Research proposal will be submitted to Research and Ethical Committee at Makerere University for approval. A letter from the Committee will be taken to Mulago Hospital management and ART clinic to seek permission to pre-test the Questionnaire. The same letter will be taken to Kayunga District hospital management and ART clinic where data collection will be done to seek permission to carry on data collection among HIV-infected clients on 1st —line ART regimens”.

3.9 Limitations of the Study

These are anticipated challenges imposed by methods, period and location of research.
The researcher may not have control over them and therefore the need to identify them so that possible solutions before beginning the study.
They also help in predicting the necessary help need and the feasibility of the research.
Explain the constraints you are like to meet and how you overcome them.

For example: “The researcher expects to encounter time constraints in the course of study, balancing the research study and other demanding work. The researcher will overcome this limitation by drawing up a time table that will be strictly followed”

3.10 Dissemination of Results

Research findings must be shared to the relevant concerned bodies who might be interested in your findings.
It can also be published as reports, journals, CMEs, posters in conferences etc.
Dissemination helps other scholars know what has been done.
List how and where you will communicate your results.

For example: “Information from the study wilt be compiled into a research report and four copies of research report will be made. A copy will be submitted to; Makerere University, Kayunga Hospital ART clinic, Research Supervisor and the Researcher.

References/Bibliography

This includes all sources of cited, used and have been reffered too in he write up.
It is a list of all authors whose work has been used in your proposal.
This is written following the referencing guidelines of any institution.
APA style is the preferred for our case.

Reference list:
This is an important part of the proposal. In the literature Review and in Background, you must have cited various authors. The page on References must show all the details about all the citations made in text.

Example;
References

Byakwaga. Ff., murray,1., Petnumenos.K. (2E104). Prognosis of CPA in persons receiving ART. Aids Res Hum Retroviruses: 75(6):756-76
CoIlia., Diedrichl. 6 JoAnna. (711U8). Unexpected low-level viremia among HIV-infected Ugandans adult with untreated active LB, i.acquir immune Defic synd.119:458
Daar, E.. Mnudgil, T. 6 Meyer, R. (1991): Transient high levels of viremia in patients with primary human immunodeficiency virus type l infection. N Eng! J Med: 324(14):961-4

Appendices

These extra things necessary for you to finalise your proposal
They include;
- Budget
- Work plan
- Consent for patients
- Data collection tools
- Any other necessary document

Budget

Budget	Example:
1. Stationery
– 10 reams of duplicating paper @shs 10,000	100,000
– 3 boxes of pens @ 8,000	24,000
Sub-total	124,000
2. Travel
– 5 return trips @ 10,000	50,000
Sub-total	50,000
Total	174,000

(Note: This example is for illustration purposes. Actual research budgets can vary significantly.)

Consent form:

Informed consent is the authorization granted with an awareness of the possible consequences, provided by the respondent to the researcher for their involvement in the study. (With a complete understanding of potential risks and benefits)

A consent form is the documentation that demonstrates the occurrence of the informed consent process.

Essential Components of the consent form:

A clear and concise elucidation of the research’s purpose, incorporating the study’s title.
An account of the procedures participants will undergo during the study, along with an indication of the time commitment for each element.
Explanation of potential risks, side effects, or discomfort associated with the procedures.
Detailing of potential benefits.
Declaration that the participant’s engagement is voluntary, and they retain the right to withdraw without facing any repercussions.
Assertion that the participant is permitted to raise inquiries regarding the study.
Outline of the measures in place to safeguard participant confidentiality.
Explanation of the data’s use after the study concludes.
Confirmation that the participant shall receive a copy of the signed and dated consent form.
Identification of the investigator(s) and contact information.
A “statement of consent” along with the participant’s name and signature.
Identification and signature of the person obtaining consent.

Example of a consent form

Consent Form

Introduction

Dear participant,

I am Tusing, a student pursuing a Diploma in Nuring at Nurses Revision school of Health Sciences. I am conducting a research study on the most effective first-line ART regimen among HIV-infected patients at Kayunga Hospital.

By participating in this study, you will contribute to preventing drug resistance and lowering mortality rates among HIV-infected patients at Kayunga Hospital. We do not foresee any risks to you during the course of this study.

Confidentiality: If you agree to participate in this study, the information obtained during the study will be kept confidential and will only be accessible to the researcher and the supervisors. Your name is also not needed on the questionnaire in order to participate in the study.

Voluntary Consent: You are free not to participate in the study and you have the right to refuse answering any question that you feel uncomfortable with. You are also free to withdraw from study at any time without fear of any consequences.

By signing below, you indicate your comprehension of the information provided about this study, and you willingly provide your consent to participate.

Name of respondent………………………….Signature of the respondent…………….Date…………….

Name of researcher…………………………Signature of the
researcher………………Date…………

Workplan

METHODOLOGY Read More »

LITERATURE REVIEW

CHAPTER TWO: LITERATURE REVIEW

Literature review refers to the collection of scholarly information about any research problem/topic

It is a systematic gathering of information, analysing and reviewing documents from written or done by other scholars that have a relation to your problem being investigated
It is a requirement for ay researcher to do a preliminary background search of information about a problem so that one discovers what has been done and what the gap in the field of study is.

This chapter contains only one item, i.e. literature review.

Purpose of literature review

To identify what is already known in your area of study
To justify why you need to study the problem you are interested in since it identifies the gaps.
To orient the reader on how the research will be used to make discussion of the findings.
To know what has been reported so that you report on what needs to be reported on.
Forms part of the research process.

Sources of literature review

Primary data sources

This is where we get the data from the first hand information especially the people who existed, observed and witnessed the occurrence of a certain event

Secondary sources

This is where we get the literature from the second hand information like published data, articles books, etc written by people/Authors who were not present when these events were happening.

Examples of secondary sources

Journals
Articles
Text Books
Reports
Government documents
References quoted in books
Abstracts
Grey literature- any written material but not published
Internet –computer search etc

UNMEB PAST EXAM: Outline 10 reasons why you reviewed the literature?

Contextualization and Background: Literature review provides a historical and theoretical context for the research, helping readers understand the evolution of the topic and its relevance. Literature review helps you understand the story of your research topic. It’s like reading the background of a patient’s medical history before treating them.
Identification of Gaps: Reviewing existing literature helps researchers identify gaps or unanswered questions in the field, highlighting areas where further research is needed.
Building a Theoretical Framework: Literature review helps in constructing a solid theoretical framework by integrating relevant theories and concepts from previous studies. Imagine you’re learning to give injections. By reading about how experienced nurses do it, you gain insights into different techniques, potential challenges, and safety tips.
Defining Research Problem and Objectives: A comprehensive literature review guides researchers in formulating a clear research problem and specific objectives by identifying the key issues in the field. It’s like checking if someone has already tried a certain medication for a specific condition. If they have, you can learn from their successes and failures.
Research Design and Methodology: Literature review aids in selecting appropriate research designs and methodologies by examining how previous studies were conducted and what methods were employed. Literature review is like using a map. It shows you the path others have taken and helps you decide which route to follow.
Avoiding Redundancy: By being aware of what has already been done, researchers can avoid duplicating efforts and ensure that their study contributes something new to the field. Imagine if nurses gave the wrong dosage of a medicine just because they didn’t know it was dangerous. Reading about such incidents helps you avoid making similar mistakes.
Establishing Credibility: Referencing established works in the literature lends credibility to the research and positions it within the broader academic discourse. Let’s say you’re learning about hand hygiene. By reading about how infections spread in hospitals due to poor hand hygiene, you realize why your study is important.
Enhancing Researcher’s Knowledge: Literature review expands the researcher’s understanding of the topic, allowing them to gain insights, viewpoints, and nuances they might not have considered. magine you need to measure a patient’s heart rate. Reading about different types of equipment helps you choose the right tool for accurate results.
Validation of Hypotheses: Literature review helps validate research hypotheses by examining whether previous findings support or contradict the researcher’s proposed ideas. It’s like drawing lines between related dots. Literature review helps you see how different studies connect and how your research fits into the bigger picture.
Contribution to Knowledge: A comprehensive review of the literature highlights the research’s unique contribution to the existing body of knowledge, demonstrating its significance and relevance. Just like nurses investigate symptoms to diagnose patients, researchers investigate what’s known to find gaps. This way, you can contribute new information, like a detective solving a medical mystery.

What do we find in a Literature Review?

History of the Problem: This section delves into the historical context of the research issue, tracing its development over time.
Magnitude and Distribution of the Problem: This part presents data and statistics on the prevalence and distribution of the problem across different populations.
Severity of the Problem: Here, the impact and consequences of the problem on individuals and communities are discussed.
Methodology Used by Other Researchers: This section outlines the methods, approaches, and techniques employed by previous researchers.
Hypotheses and Variables: It discusses the research questions or hypotheses examined in previous studies and the variables under consideration.
Research Designs: The overall design or structure of prior research studies is explained.
Sample Size and Characteristics: The number of participants and their characteristics in previous studies are mentioned.
Research Tools Used: This part highlights the tools, instruments, or surveys used to gather data in earlier research.
Findings of Previous Research: The key findings and conclusions of earlier studies related to the topic are summarized.
Sample Size Determination: The method by which researchers determined appropriate sample sizes is discussed.
Limitations of Previous Research: This section acknowledges the limitations and shortcomings of the reviewed studies.

Writing the literature

Ensure to use the most recent literature especially not more than 10 years from the present year of study
Divide your work into themes according to your objectives e.g

2.0 introduction
2.1 literature related to objective one
2.2 literature related to objective two
2.3 literature related to objective three

Adhere to the institutions guidelines of citations and referencing e.g APA format, Harvard format of referencing.
When reviewing literature always ensure to keep a file of all the cited and referenced work.
The rationale behind this is that you may need to refer to this work from time and again.

Guidelines for Conducting a Literature Review:

“A fight of win or loss”: It’s important to remember that a literature review involves finding supporting or contrasting references for your statements. Therefore, avoid writing paragraphs without at least two references to back up your claims.
- Example:
  “A study done in Botswana showed that male
  adolescents are at higher risk of suboptimal adherence to
  ART than females (Ndiage, Nyasulu, Nguyen, Lowenthal, .et al, 2013). This is in conflict with a similar study done in South Africa, which indicated that being a female is a major risk of poor adherence (Wasti, Simkhada & Teijlingen, 2012).”
  • Literature review is full of comparisons and similarities of
  results from studies done by other researchers in different
  parts of the world.
  • It’s more of paraphrasing.
  • Where possible state the results (figures) of the study
  your are paraphrasing
Comparisons and Similarities: A literature review involves drawing comparisons and identifying similarities in research outcomes across various studies conducted by researchers worldwide.
Emphasis on Paraphrasing: The literature review heavily involves paraphrasing and synthesizing existing research findings to provide an integrated understanding of the topic.
Incorporating Results: Whenever possible, include the results or figures obtained from studies you are referencing. This helps in presenting a clear picture of the outcomes and insights from those studies.
- Example: ‘A study done in South Africa showed that patients were significantly more likely to be adherent on the efavirenz (taken once a day) than the nevirapine (twice a day) -based regimen. 38.2% (696 of 1,822 patients) maintained 100% adherence versus 30.1% (301 of 999 patients) in the nevirapine-based arm. (Theos, 2007)”
  • As you quote in literature review indicate; the name of
  study. Author, year, setting (where it was done), target
  population and Results as seen in the above example.

Whenever you are writing someone’s work, you have to acknowledge the person who did the work, and in research, we call that REFERENCING.

REFERENCING

Whenever you use someone else’s words or ideas in your research paper, you must indicate that this information is borrowed by quoting the source of information in the paper its self (in text referencing), and at the end of the paper (reference list).This applies to written sources you have used such as books, articles web pages, E.T.C. Reference is used to tell the reader where ideas from other sources have been used in the research paper.
Importance of referencing:

– Referencing gives credit to others for their work and ideas.
– Referencing gives your argument evidence, credibility and
authority.
– Referencing allows the reader to track down the original work if they choose to read more about it (a reference act as a sign post that tells the reader the source of facts, theories and opinions).
– It shows the reader how your argument relates to the big picture.
– If you do not acknowledge another writer’s work or ideas you could be accused of plagiarism (plagiarism is the intentional or unintentional presentation of another’s work as your own).
– It shows the reader that you created a solid argument.
– It is a way of distinguishing your ideas from those of other sources.
– To reinforce your argument.
– To allow fact-checking.

Types of referencing/ citation style for a research paper.

The two commonest styles used are;

APA (American psychological Association) style.
MLA (Modern Language Association) style.

Other styles are;

Vancouver style / author-number system)
Chicago style
Turabian style

NB: With all referencing styles, there are two parts to referencing;
citing (in-text referencing), and the reference list.

APA (American Psychological Association)

It is a style of referencing (The most commonly used style in research). APA recommends in-text citation (referencing) that refers readers to a list of references (at the end of your work on a separate paper).

APA in-text referencing

APA in-text citation style uses the author’s Last name (sur name) and the year of publication and at times (but not all times) a page number.

Example
“Diabetes mellitus is associated with development of hypertension” (Kayizzi & Serugo, 2015, p. 36)
OR
Diabetes mellitus is associated with development of hypertension (Kayizzi &. Serugo, 2015).

OR
Kayizzi and Serugo (2015) reported that “Diabetes mellitus is associated with development of hypertension” (p. 36)
Note
– APA uses the ‘author-date’ style of referencing.
– When directly quoting from a source, you must include page number(s) and close the quote in double quotation mark.
– If you are referring to an entire work, include only the Author’s last name and year of publication. If you are referring to part of a work you must include page.

APA referencing list

The reference list should appear at end of your work on a separate page.
Only include references you have cited in your work.
All references should have a hanging indent. That is, all lines of a reference subsequent to the first line should be indented.
In general references should be in alphabetized by last name of first author of each work.

Example of referencing list:
Journal article
Kayizzi, G., & Serugo, I. (2005). Diabetes mellitus is associated with development of hypertension. The lacent, 9 , 36.

Note the Sur name ( Kayizzi), first initials (G).,& sir name of 2nd author (Serugo), initial (I).year of publication(2005) title of the article (Diabetes mellitus is associated with development of hypertension). Name of the journal in italic( The lacent)Volume(9) page(36)

Text book
Kayizzi, G.(2014) Managing Diabetes Mellitus. Kampala:
Ink co.

Note the title of book is underlined or bolded, and then
the city and publisher come last.

How do reference or cite?

This is the recognition of statements or findings of another author that have been used in your literature of research or any other write up.
- Referencing refers to the list of all authors whose work has been used to build up your research and it comes at the end of research.
- Citation refers to the acknowledgement with in the text/your work.
Note: All cited authors must appear in the reference list

Importance of citation

To avoid plagiarism
To recognise the efforts and the ideas of the original authors
Enable the reader find the location of the quoted ideas/work.
Demonstrate your ethics and integrity in research.
Showed you have widely and extensively searched/read about your topic.

Ways of citing

Citing with in the text
Quotations
Foot notes

Ways of Citing in Research

Citing Within the Text

There are two methods for citing within the text:

Parenthetical Citation: In this method, the author’s last name and the year of publication are placed at the end of a paraphrased statement, both enclosed in parentheses. For instance: The research demonstrated a significant correlation between class performance and absenteeism (Sabiti, 2019).
Narrative Citation: This method involves placing the author’s name and publication year at the beginning of the sentence. For example: According to Sabiti (2019), there exists a noteworthy correlation between class performance and absenteeism.

Quotations

Quoting directly involves using the exact wording of the author’s statements without alteration. Direct quotations are preferred for:

Ensuring accuracy in conveying the original message.
Utilizing exceptionally clear statements.
Adding emphasis and authority, especially when quoting from a recognized author.

Footnotes

Footnotes are used to display references at the bottom of the page rather than at the end of the main text. Its role is to provide additional information to the reader and to indicate the source of the idea. They serve two primary purposes:

Providing Additional Information: Footnotes offer supplementary details to enrich the reader’s understanding of the content.
Source Indication: Footnotes attribute ideas to their sources, ensuring transparency and proper citation.

For example; the likelihood of acquiring HIV can be expected from people with multiple sexual partners 1.

In this case number 1 represents the first citation of your work and will appear as your number one list of references.

Exam”: https://midwivesrevisionuganda.com/research-cumulative-exam/

CHAPTER THREE: METHODOLOGY

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LITERATURE REVIEW Read More »

PRINCIPLES OF TEACHING AND LEARNING

The principles of teaching and learning will assist the teacher to achieve purpose of teaching. It guides the teacher on the elements pertaining teaching such as whom to teach, why teach, where to teach, what to teach, how to teach and when to teach.

Principle of motivation: The best teacher is one who inspires students. This provides an atmosphere of confidence and helps student to develop positive attitude towards the subject
Principle of activity: Teaching should aim at having students active not passive. Teachers should set various tasks which learners should get involved in like discussion, assignment, case presentation e.t.c
Principle of individual difference: Teaching should respect individuality of students by considering each student as unique
Principle of selection: Teachers should select appropriate content, teaching method or aids basing on the level and needs of learners
Principle of division: Teaching should have definite division into steps and sequenced appropriately e.g lesson of cardiac failure can be broken down into definition, types, pathophysiology, clinical feature, diagnosis and management
Principle of correlation or association: The previous knowledge should correlate with present knowledge because our brains were not designed to recall information in isolation e.g teaching medical or surgical nursing requires knowledge of anatomy or foundations of nursing
Principle of creativity: Teaching should allow learners to come up with new ideas or suggestions from the content taught. So the teacher should also set activities allowing room for innovation
Principle of revision and practice: Teaching has to ensure revision or summarizing the content at the end and encourage practice of learned content periodically
Principle of objectives: Teaching has to have well-defined objectives in order to ease content delivery and evaluation
Principle of effect: Behaviour that leads to satisfying outcomes are likely to be repeated whereas those that lead to undesired outcomes are less likely to recur. Teaching activities should lead to the best results so that students can continue practicing them
Principle of connection to real life: Teaching should relate the content taught to real life so that it maintains the learner’s attention span and understanding. For example, teaching in nursing has to be connected to lived experiences and that of the patient.

LESSONS LEARNED FROM THE PRINCIPLES OF TEACHING

Subject matter must possess meaning, organization, and structure.

Meaning: Content becomes more meaningful when learners understand how the subject matter can be applied.
Organization: Content should be divided into instructional units that clearly demonstrate the usefulness of what is being taught.
Structure: Content must be sequenced in a way that allows learners to see and comprehend the interconnectedness of concepts.

Readiness is a prerequisite for learning.

Educators must familiarize themselves with their learners’ interests, aspirations, aptitudes, and prior knowledge.
Learners demonstrate their readiness for instruction.
Instruction should be tailored to the experiences and contexts that make students willing and capable of learning. This state of readiness is highly valued by many educators.

Learners must be motivated to learn.

The finest educators inspire students and foster their active involvement during teaching.
Motivation to learn encompasses factors that influence learners to engage in and successfully complete learning activities.
Motivation is influenced by personal and environmental factors.

Teaching needs to have well-defined objectives.

Teaching activities should be based on predetermined objectives to achieve favorable outcomes.
Learners are motivated by clearly established learning goals.
Objectives guide the selection of content, delivery methods, and evaluation.

Success is a motivating force.

Learners are motivated when they acquire new knowledge and skills.
Educators should create learning activities where attainable success is achievable through proper instruction and supervision. Unrealistic standards for assessments should be avoided.

Learners are motivated when they are challenged.

Tasks should present a level of challenge where success is attainable but not guaranteed.
Educators must acknowledge that what is achievable for one learner might be unrealistic or uninteresting for another.
Instructional material should cater to various difficulty levels and encompass a range of activities.

Learners must receive feedback on their learning progress.

Feedback should encompass both strengths and weaknesses in a learner’s academic performance.
Feedback mechanisms can be individual or group-based.
Behaviors that are reinforced (rewarded) are more likely to be learned.
Reinforcement should be perceived as rewarding by the learner and not solely by the educator.

Criticism should be used cautiously as research shows a negative relationship with that and academic achievement.

Negative feedback should always be accompanied by instruction on how to correct errors.
Reinforcement should follow the desired behavior as promptly as possible and be clearly linked to the student’s actions.

Directed learning is more effective than undirected learning.

Directed learning involves ensuring that both educators and learners comprehend what is transpiring and why.
Directed learning necessitates strategic instructional planning and skillful supervision.
Learning should involve inquiry rather than strict instruction in the subject matter.
Active learning is superior to passive learning.

Problem-oriented approaches enhance learning.

Problem-oriented approaches ensure that all learners can actively participate in instruction.
Revision and practice are crucial.
Teachers must summarize content and encourage students to practice.
Learning results from practiced actions.
Proper technique practice with feedback is essential for success.

Content should be connected with real life.

Retention of learning is increased when it is applied in real-life scenarios and quickly utilized after acquisition.
Practice should closely mirror the real-life context in which behavior, skills, or attitudes are utilized.

Teaching should be correlated.

Content must correlate with previous or related knowledge, offering learners a comprehensive understanding of the subject matter.
Generalizations, rules, or formulas aid knowledge retention.

Individual differences should be considered.

The teacher should recognize the uniqueness of each student and pay attention to individual differences.

QUALITIES/CHARACTERISTICS OF GOOD TEACHING

Good teaching involves the following:

Recognizes individual differences: It should consider every student as unique.
It should cause learning to take place: It allows change in behavior, i.e., they should be able to do or know something they did not know.
It involves guiding learning: It helps to develop desirable learning habits to achieve a desired aim, i.e., it should have well-defined objectives.
It provides an opportunity for activity: It should keep students as active learners but not passive.
It’s kind and sympathetic: It should make students comfortable in the presence of a teacher but not be threatened.
It should be flexible and use any teaching method to cater to learners’ different learning.
It should reduce the distance between teacher and student hence enhance teamwork.
It’s democratic: The teacher has to allow students to think and express their ideas freely but should remain in control and guide them appropriately.
It should provide desirable and selective information: The teacher should deliver information that is appropriate to the needs and level of students.
It should help the child to adjust to his/her environment: Making a child able to survive and live a productive life in society.
Consider the level of the student: Teaching should be based on the previous knowledge of the student, level of intelligence, and intellectual maturity.
It should be progressive: Teaching should enhance further development of the student to reach good positions in life.
It should be stimulating/motivating: The teacher must elicit the interest of learners with their enthusiasm for the subject, teaching method, and aid used.
It should be planned: The teacher should take prior time to plan and develop well-defined objectives. Otherwise, it implies if one fails to plan, then they plan to fail.”
It’s diagnostic and remedial: Teaching should find out educational problems of students then come up with remedial measures to address the problems.
It should be correlated: The present knowledge obtained should relate to the previous content, not distinct.

MAXIMS OF TEACHING

These are general rules of conduct to be followed by a teacher while teaching.

Proceed from known to unknown: The teacher should correlate learning with the student’s experience and previous knowledge so that the content starts from what is known and then proceeds to what is unknown.
Proceed from simple to complex: It’s also important to begin with the simplest lessons and then introduce more complex ones later. In other words, teach in increasing order of difficulty.
Proceed from overview to details: Students can easily understand if the teacher first provides an overview of the lesson and then delves into the details of the content.
Proceed from general to specific: General rules are explained first, followed by the delivery of specific information.
Proceed from specific to general: At times, it’s necessary to start with specific facts before presenting them in a general context.
Proceed from easy to more difficult: The content should be taught in increasing order of difficulty.
Proceed from concrete to abstract: Students should grasp new ideas when they are initially taught with simple illustrations (concrete aspects) before moving on to mental reasoning (abstract aspects). Therefore, start with observations and progress to intellectual reasoning.
Proceed from empirical to rational: Empirical knowledge is gained through observation and experience, while rational knowledge is based on scientific principles. Thus, it’s essential to begin with live examples and then advance to scientific reasoning.
Proceed from whole to parts: The whole holds more meaning for students compared to individual parts. Teaching the skeletal system (functions, number of bones) as a whole and later breaking down each bone’s details (e.g., femur, clavicle) allows for better correlation.
Proceed from parts to whole: In some situations, it’s beneficial to start with parts and conclude with the whole to enable students to generalize the content. For instance, teaching the advantages of rectal, oral, and sublingual routes separately before discussing the advantages of enteral routes as a whole.

PRINCIPLES OF TEACHING AND LEARNING Read More »

PHILOSOPHIES OF EDUCATION

Philosophy refers to search for wisdom and truth or the study of the principles of human behavior and reasoning

Education is the process of facilitating learning, or the acquisition of knowledge, skills, values, beliefs, and habits.

There are various ways how learners can use to search for the truth of what has been taught.

These philosophies used in education include:

Idealism
Realism
Naturalism
Pragmatism

IDEALISM:

It is derived from the term ideals. It is a philosophical approach that believes that ideas are the only true and reality worth knowing.
Truth, knowledge and values are simply the conception of the mind or spirit; therefore the mind is the controller and explainer of the phenomenon that we are seeing or have heard e.g things such as planets, legends, plants exist because the mind that perceives them.
The physical world can be changed through the ideas or imagination of man. If one believes that the world is round even when he/she has not seen it is the truth. This philosophy is mainly used in religious doctrines.
In education, philosophy is mainly applied by junior students where many things taught have not been seen but the mind needs to believe that they exist like the brain, heart, nerve transmission.

Implications of Idealism in education.

Education is supposed to be a process of turning the eye from darkness into light.
The role of education is to activate the mind, so that through its reasoning, it can discover knowledge. It places importance on question-answer or logical reasoning as the method of acquiring information or gaining knowledge.

IDEALISM MADE SIMPLE:

Idealism is like dreaming about your favorite things. It’s a way of thinking that believes the stuff in our minds is the most important and real. This includes things we know, like how to be good, and things we can’t see, like love.

Imagine you have a superhero friend in your head. This friend helps you understand everything around you – from big stuff like stars and stories, to smaller things like plants. This idea says that because you can think about them, they exist in a special way.

Guess what? Idealism also says that what you think can change the world! For instance, if lots of people imagine the Earth is round, even if they’ve never seen it from space, it becomes a powerful idea.

This way of thinking isn’t just for school, it’s also used in believing things like kindness and hope. Even though you can’t touch these, they’re real because people think about them and act on them.

In school, when you learn about things you can’t see, like your brain or your heart, idealism helps you believe in them. It’s like having faith in things that are real even though you can’t hold them in your hand.

Here’s a cool thought: education, which means learning new things, is like turning on a light in your mind. It helps your brain discover knowledge and answers. Idealism likes when you ask questions and use your brain to figure things out. It’s like being a detective and finding clues to understand the world better.

So, idealism is all about how your thoughts and ideas are super important, and they can make a big difference in the world, even if you can’t see them with your eyes.

REALISM

The term ‘realism’, derived from the word ‘real‘, refers to the theory that whatever knowledge we receive through the senses (sight, touch, smell, etc.) is a true reflection of what really exists. Things we see or perceive are real, and knowledge acquired through senses only is true.

This philosophy is applied by most curious learners who will only believe in things they can sense. For example, you can know that fire burns after touching it.

Implications of Realism in Education

The arrangement of the world into patterns implies that knowledge is classified according to disciplines or subjects. Hence, the realists suggest that the curriculum should be broad-based and include a variety of subjects, especially science subjects.
Therefore, no single subject/discipline can be adequate to express the whole truth of the matter.
There are no bright/dull children; they only differ in their rate of grasping knowledge.

REALISM MADE SIMPLE:

Realism is like believing your eyes, ears, and nose. It’s the idea that what you see, feel, or smell is the real deal. Everything you sense is like a true picture of what’s actually there.

Imagine you’re a super-spy using your senses to find clues. Realism says that the things you find with your senses are true and exist. Like, if you touch fire and it burns, that’s real knowledge.

Realism is perfect for curious learners who trust their senses. They believe things when they can see, touch, or experience them.

In school, realism helps us organize knowledge into different parts, like subjects in school. It’s like putting puzzles together to understand everything better. Realists think that schools should teach many different things, especially science, to get a full picture of the world.

Realism also reminds us that every person is like a learning champion. Some people learn fast, and some take more time, but it doesn’t mean anyone is better or worse. We all just learn at our own pace.

So, realism is all about trusting your senses, using them to learn lots of things, and understanding that we’re all amazing learners in our own way.

NATURALISM:

Naturalism views that nature is the source of knowledge.
Here the naturalists also believed that the process of growth and development in man was the result of force of energy prevailed in nature.
In education, naturalists want educators to focus on things that exist in nature so that learners can connect to real life.

Education Implications of Naturalism:

Naturalism considers the child as a gift of nature with potentialities for natural growth according to the laws of nature.
The powers of the child should be developed in natural ways by allowing the child to freely interact with nature.
The curriculum should provide concrete and real experiences in a natural context, i.e., the child should learn by interacting with nature.
Morality and character are learned directly with the help of natural consequences. It advocates learning without tears; this means that in a learning set-up, never punish the child. If there is punishment needed, nature will take its course and punish the child.
Inequalities and bad behaviors are a result of the child’s intercourse with the corrupted society.

NATURALISM MADE SIMPLE:

Naturalism is like learning from nature itself. It says that nature is where we find all our knowledge.

Imagine that nature is like a big, powerful force that helps us grow and change. Naturalism believes that the way we become smarter and better is because of the energy from nature.

In school, naturalism tells teachers to focus on things we see in nature. This way, we can learn about things that happen in real life.

What Naturalism Means for School: Think of every child as a special gift from nature. They have their own unique abilities, just like nature intended.

Kids should learn and grow in a way that feels natural. It’s like playing outside and exploring nature – that’s how we learn best.

School subjects should be connected to real things we find in nature. Imagine going on a nature adventure to learn about science and other cool stuff.

When it comes to being good and having good character, nature teaches us. So, teachers don’t need to be too strict. If we make a mistake, nature will show us how to fix it.

Remember, when people do unfair or bad things, it’s often because they’ve been influenced by a not-so-great society.

Naturalism is all about learning from nature, growing the way we’re meant to, and understanding that nature is a powerful teacher that guides us to be our best selves.

PRAGMATISM:

It comes from the Greek word “pragma,” which means work/action. This is a philosophy that judges all things in terms of their practical consequences. It holds the view that for anything to be called knowledge, it should produce a physical observable/tangible change in things.

Only those things that are experienced/observed are real.

Education Implications of Pragmatism:

The idea of placing children in the most desirable environment for their education.
The ideal education as being exposed to many experiences.
“Learning by doing,” which encourages the child to learn through activities.

PRAGMATISM MADE SIMPLE:

Pragmatism is like focusing on what works in real life. The word comes from “pragma,” which means action or work. This way of thinking believes that the most important thing is what happens because of what we do.

Imagine if something doesn’t make a real difference – according to pragmatism, it’s not really useful. This philosophy thinks that for something to be considered knowledge, it should actually change things in a noticeable way.

Pragmatism says that only things we can see or experience are truly real.

What Pragmatism Means for School: Think about being in a place where you can learn the best. Pragmatism likes that idea, too. It’s all about making sure students are in an environment that helps them learn well.

Pragmatism also loves the idea of learning from lots of different experiences. It’s like collecting different tools to solve problems.

Remember when you learn best? It’s when you’re doing things, right? Pragmatism agrees. Learning by doing, like hands-on activities, is a big part of this philosophy.

Pragmatism is about focusing on what’s practical and useful, finding the best way to learn, and making sure that what we learn helps us change the world around us.

PHILOSOPHIES OF EDUCATION Read More »

Writing a research proposal

Research proposal refers to the description of what the researcher wants to investigate, why it’s important, and how the research will be done.

The format of a research proposal varies between fields and from institution to institution

Note: A research proposal is written in the future tense because it tells the reader what the researcher intends to undertake.

Read the above NOTE again Please!

Importance of Writing Research Proposals.

Securing Funding: Research proposals allow nurses to request financial support or grants to conduct their proposed studies. This funding is vital for obtaining necessary resources, such as equipment, materials, and personnel, required for the research.
Guiding Research: A research proposal acts as a roadmap for the researcher. It outlines the plan and steps to be followed throughout the research effort, helping nurses stay focused and organized as they conduct their studies.
Meeting Certification Requirements: Research committees often require a well-structured proposal before approving studies involving human or animal subjects. Writing a research proposal ensures that the necessary ethical considerations and safeguards are in place before the research begins.
Generating New Ideas: The process of writing a research proposal stimulates critical thinking. Nurses often gain deeper insights into their chosen topic and generate new ideas during the proposal-writing stage.
Establishing Feasibility: A research proposal forces nurses to consider the practical aspects of their projects. It helps in estimating the time, resources, and effort required, ensuring that the research is feasible within the available constraints.
Educational Requirement: Many tertiary education programs in Uganda require students to write research proposals as a prerequisite for embarking on a research project or dissertation. This prepares nurses for the rigorous research process ahead.
Anticipating Limitations: Writing a research proposal encourages nurses to identify potential limitations and challenges that may arise during the study. This proactive approach allows for better planning and strategizing to overcome these obstacles.

Aims of a research proposal

A research proposal aims to achieve the following objectives:

Captivating Interest: Your proposal should convince readers that your research project is engaging, original, and holds significance in the field of nursing. It should highlight the importance of your study’s contribution.
Demonstrating Expertise: By showcasing your familiarity with the subject and the existing research landscape, your proposal establishes that you have a solid understanding of the current state of knowledge in the field.
Validating Methodology: The proposal outlines your chosen research methodology, indicating that you have thoughtfully considered the tools, data, and procedures required for a rigorous and valid study.
Practical Viability: Your proposal should confirm that your research project is feasible within the practical limitations of your program, institution, or available funding. This demonstrates that your study can realistically be conducted as planned.

How to write a research proposal

Contents/ components of a research proposal:
The proposal consists of; a title/ topic, chapter 1, chapter 2, chapter 3, reference list, and an appendix with; a budget schedule, and other relevant information such as questionnaire and map of study area.

TITLE PAGE

This includes:

The proposed title of your research
Your name
Index number
The institution and department
The year
The layout varies from institution to institution

PRELIMINARY PAGES

Title Page
Declaration Page
Abstract
Copyright Page
Authorization Page/Approval page
Dedication
Preface or Acknowledgement (if applicable)
Table of Contents
List of Figures
List of Tables
Definition of terms
Abbreviations

MAIN BODY – BODY OF THE PROPOSAL

A research proposal mainly consists of three chapters;
1. Chapter one- Introduction
2. Chapter two- Literature review
3. Chapter three- Methodology

Finally, there should be REFERENCES and APPENDICES (APPENDIX)

REFERENCES

Appendix I: Consent Form
Appendix II: Research Work Plan
Appendix III: Estimated Research Budget
Appendix IV: Questionnaire for Participants
Appendix V: Sample Size Determination

CHAPTER ONE – INTRODUCTION

This tells us in detail what your study is all about. It intends to introduce the topic to the readers interested in your research.

It has the following sub sections;

1.0 Introduction of the chapter
1.1 Background to the study topic
1.2 Problem statement
1.3 Purpose of the study
1.4 Specific objectives
1.5 Research questions
1.6 Justification of the study

1.0 Introduction of the chapter

This briefly summarises the what the chapter is all about.
It aims at giving the reader what he/she should find in this chapter.
It provides information to prepare the minds of the readers to comprehend the problem under investigation.
Describe your topic i.e. describe your dependent variable (define it & link it to the independent variables where possible).
Provide evidence of the existing problem from a universal view to local (global, continental, regions, countries), highlighting the gaps.
Make the reader understand the past (origin), present, and future states of affairs/problem.
Introduction should not exceed 2 pages (About 600 words, Font type: Times New Roman, Font size 12; 1.5 line spacing) – Makerere Research format.
Use APA (American Psychological Association) for in-text referencing in the introduction.

1.1 Background to the study topic

An overview of the study and what is its context/situation across different regions in the world.
Understand the situation of your research problem globally, regionally and locally
It is an in-depth explanation of how big is the problem you are studying
It aims at convincing the reader that your problem is worth studying
Usually it should not exceed three pages

1.2 Problem statement

The problem statement must be concise and clear, not exceeding one page. It should address the following seven questions:

To what extent is the problem manifested statistically?
What is the state of the problem in your country?
How does the problem progress over the years, for example, in 2007, in 2008, and so on (you can reference studies)?
What is the effect of the problem on the target population?
What efforts have been made to address the problem, e.g., by government ministries, organizations, etc.?
What is the existing gap? (For instance, despite…, comparing the magnitude of the problem…)
What is the proposed way forward? (e.g., therefore, I need to conduct the study”)

It therefore summarizes the following;

- Magnitude of the problem
- The actual problem
- Consequences/Effects of the problem

1.3 Purpose of the study(Aims)

Also called GENERAL or BROAD OBJECTIVES.
Refers to the general intention of the research.
Should spell out what the research is supposed to accomplish.
It is usually duplicated from the topic but with an element of action in it. For example: To identify/establish the factors affecting the rate of spread of bedbugs among male students in Gaddafi hall at Mulago 😂
When stating the objective, make sure it is complete (indicate the target population and study area).
When writing the objective, do not use words with immeasurable elements such as to study, understand, or know. Use words like Evaluate, Assess, Examine, Establish, Investigate, Identify, Determine, Extent, and Magnitude.

1.4 Specific objectives

Not more than 4, not less than 2, Average 3 specific objects in number.
Objectives must be SMART:
- S – Specific (to one thing) – meaning that it should clearly state what the researcher intends to achieve. This means to should be free from any unclear interruptions
- M – Measurable: do not use words like to study, understand, and know. Use words like Evaluate, Assess, Examine, Establish, Investigate, Determine, Extent, and Magnitude.
- A – Achievable (Time frame and cost).
- R – Realistic (address a topic at hand) – the objective must be stated in a sensible and practical idea of what can be expected and achieved.
- T – Time-bound – what the researcher wants to do should be set to be done in a given period of time
Directly related to the problem (Every objective should be answering a title/topic).
Relevant to a particular study.
Appropriately worded (Objectives must be complete (E.g. stating the target population and study area (location)).

1.5 Research question(s)

Research questions are like specific objectives but with question Marks (?)
These are directly extracted from the specific objectives of the research
They are stated in the questions form so that at the end of the research, we can evaluate to see if these questions have been answered

For example:

Objective: To assess the knowledge of mothers towards oral medicine administration of there children below 5 years.

Question: What knowledge do mothers have towards administration of oral medicine to there children below 5 years?

1.6 Justification of the study

To justify is to defend, to give reasons why or to give an explanation. Justification of the research problem is to explain to the reader why this study is worth to be done. Also known as Significance of the study.

Why? (Would the world collapse if this research is not conducted?)
Why have you chosen that specific part of the world for your study?
Whenever possible, use statistics to reinforce your point (e.g., “Hospital records show that observation…,” “On observation…”).
Should not exceed more than one paragraph.

Significance:

Can be interconnected with the justification.
How does it benefit the target population, Ministries, hospitals, NGOs, etc.?
Significance pertains to the study’s relevance both academically and in practical applications. (For example, “Upon completion, this study’s results will prove valuable in…”)

Do the quiz below to test yourself. They are only 10 Objectives.

[quiz-cat id="7128"]

CHAPTER TWO: LITERATURE REVIEW

Click Here

Writing a research proposal Read More »

Community dialogue

Community dialogue is a two-way communication process that involves critical analysis and in-depth understanding of the issue and concerns that affect the health and well being of the people.

It also has the same meaning as participatory or interactive communication which involves exchange of information, ideas and opinions between individuals, communities and stakeholders to enhance understanding, setting of priorities and working out possible solutions.
This is guided by the principles of mutual respect ,teamwork and shared vision.
This approach re-energizes and re-direct the community potential to recognize and appreciate their role in promoting their health and well-being. This is done through participatory communication, both the households and communities as consumers and primary provider of health and health workers as service providers will appreciate the need to learn from each other and subsequently embrace the need to change their attitudes and practices towards each other and their own health.

Importance of community dialogue.

Enhancing community partnership for health and development.
Focusing on the problem to be solved together by the concerned parties basing on the existing experience capacities and opportunities rather than predetermined massages that must be communicated by one party and received by others.
Enhance capacities for action and promoting behaviour change as parties.
Advocating for a supportive environment to promote health and community well being.
Promoting active community participation and sense of ownership for health.
Enhancing interphase between communities and health facilities.
Mobilizing the resources and ensuring proper use to promote health.
Developing an integrated and coordinated approach to promote health.
Promoting early treatment seeking behaviour ,referral and follow-up system.

It is through this approach that communities and households can be empowered to take health as their personal responsibility , intiate and participate in the activities that promote their well being.

Levels of community dialogue.

These include:

National level
District, subcounty level.
Health facility level.
Parish and community level.

National Level

It establish a movement to champion the issues and concerns that affect the health and welfare of the people especially thevulnerable groups.
It targets policymakers , legislators ,donors ,religious , traditional and the private sector to formalize supportive policies, mobilise and allocate resources to promote community empowerment for health.

District Sub county level

This target the political and administrative leadership ,NGO , the private sector , religious and traditional institutions and social groups to enhance and facilitate , adopt and operationalize policies and allocate resources to promote community empowerment for better health of the community.

Health Facility

This is the source of service delivery for community ,it plays a role in promoting application and adoption of community dialogue for improved health.
This is done through;
Application and practice of community dialogue principles in clinic and community setting during clinical consultation and meeting.
Facilitating capacity building for community empowerment through dialogue.
Provide necessary information for and materials to facilitate deliberation and taking informed decision to key issues arising from the community dialogue question and concerns.
Promote follow up.

Parish and community level.

An intervention that disregards these two vital levels cannot succeed in terms of empowering the community and is not sustainable .
Therefore the focus of community empowerment should be at parish and the household level.
Here the emphasis is to build the capacity of the parish development committees and village health teams to adopt and implement the community dialogue approach to bring about desired change in the health and well being of the people with emphasis on children and women.

Steps to community dialoguing

Build a Dialogue Team to host the event. A team approach to convening a dialogue will help to build ownership and spread the tasks involved. The team can help you to define goals for the project.
Determine your own goals for the dialogue. Your community may have some specific goals for the dialogue itself and the information received from it. The design of the dialogue session should reflect this. Your community might want to deepen existing work in the community or reflect on lessons learned.
Determine the group of participants. Who would you like to bring together to share ideas and opinions? To minimize the effort required for recruitment, you may find it easiest to partner with an existing group. This will allow you to use their network.
Select and prepare the facilitator. Good facilitation is critical to a successful dialogue.You should enlist an experienced facilitator or someone who is a good listener and can inspire conversation while remaining neutral.
Set a place, date, and time for your dialogue. Choose a spot that is comfortable and accessible. Dialogues can be conveniently held in someone’s home, a community center, place of worship, library, or private dining room of a local restaurant. Hospitals, schools, and businesses often have conference rooms or cafeterias where groups can meet. Keeping sites convenient to the participants is key
Create an inviting environment. Seating arrangements are important in a smaller group. To assure strong interaction, place seats in a circle or in a “U” formation. Refreshments (or food for a breakfast or lunch meeting) are a welcome and appropriate sign of appreciation but are not absolutely necessary.

BENEFITS OF CONDUCTING A COMMUNITY DIALOGUE

Encourages Community Participation, Support, and Commitment: Community dialogues create a platform for active participation and involvement of community members in addressing challenges. When individuals are engaged in decision-making and problem-solving processes, they feel a sense of ownership and commitment to the solutions, leading to more sustainable behavior change.
Promotes Sharing of Information and Ideas: Community dialogues foster open communication and information sharing among community members. Different perspectives, knowledge, and experiences are exchanged, leading to a broader understanding of issues and potential solutions.
Facilitates Joint Community Assessment: Through dialogues, community members collaboratively assess their own needs, problems, and priorities. This shared assessment helps in identifying key issues and tailoring interventions to address specific community challenges effectively.
Enhances Understanding of Communities: Community dialogues provide a space for stakeholders to gain a deeper understanding of the community’s context, including its social dynamics, traditions, cultural values, and local resources. This understanding is crucial for designing relevant and culturally sensitive interventions.
Identifies Key Individuals for Partnerships: Dialogues enable the identification of influential individuals, leaders, and stakeholders within the community who can play a role in facilitating partnerships and driving change. These individuals can help advocate for and implement sustainable interventions.
Promotes Accountability and Ownership: Engaging community members in dialogue fosters a sense of responsibility and ownership over the outcomes. When communities actively contribute to decision-making and solutions, they are more likely to hold themselves accountable for implementing and sustaining those solutions.
Strengthens Social Cohesion: Community dialogues contribute to building trust, understanding, and relationships among diverse community members. This strengthens social cohesion, encourages collaboration, and empowers individuals to collectively address challenges.
Supports Local Problem-Solving: Through dialogue, community members collectively analyze problems, brainstorm solutions, and prioritize actions. This participatory approach ensures that interventions are contextually appropriate and address real community needs.
Enhances Sustainability of Interventions: Involving the community in dialogue ensures that interventions are designed to fit the local context and are more likely to be embraced and sustained over the long term. Community members become advocates for the changes they help design.
Empowers Marginalized Voices: Dialogues provide a platform for marginalized or underrepresented voices within the community to be heard. This inclusivity helps in addressing inequities and ensuring that interventions are equitable and inclusive.
Builds Consensus and Collaboration: Through open discussions, community dialogues allow diverse viewpoints to be heard, leading to the development of shared goals, strategies, and action plans. This consensus-building process fosters collaboration among community members.
Fosters Innovation and Creativity: Interaction among community members in a dialogue setting encourages the sharing of creative ideas and innovative approaches to addressing challenges, leading to more effective and sustainable solutions.

CHALLENGES OF CARRYING COMMUNITY DIALOGUE

Time-Consuming Dialogues: Community dialogues can be time-consuming, as they involve bringing together a diverse group of individuals, allowing everyone to voice their opinions, and facilitating a meaningful exchange of ideas. The process of reaching consensus or understanding can take a considerable amount of time.
Poor Preparation and Planning: Insufficient preparation and planning can significantly impact the quality of a community dialogue. Lack of clear goals, agenda, facilitation techniques, and materials can lead to confusion, unproductive discussions, and failure to achieve meaningful outcomes.
Objectors Refusing Participation: Some community members may object to participating in dialogues due to various reasons such as skepticism, lack of trust, or differing viewpoints. Their absence can hinder the representativeness and effectiveness of the dialogue process.
Lack of Resources: Insufficient resources, whether financial, logistical, or human, can limit the scope and reach of community dialogues. Without adequate resources, it can be challenging to organize, promote, and sustain dialogues over time.
High Expectations: Unrealistic or overly ambitious expectations from community dialogues can lead to disappointment and frustration. When the outcomes don’t meet the heightened expectations, it may discourage participation and undermine the dialogue process.
Lack of Unity and Cooperation: Effective community dialogues require participants to work together, share ideas, and find common ground. If there’s a lack of unity and cooperation among participants, the dialogue can become contentious and unproductive.
Hostility of Community Members: Hostile or confrontational attitudes among community members can create a challenging environment for productive dialogue. Personal conflicts or deep-seated disagreements can hinder open and respectful communication.
Insecurity: Insecurity, whether physical or emotional, can prevent community members from participating freely in dialogues. Fear of reprisals, discrimination, or harassment may discourage individuals from expressing their views openly.
Endemic Diseases: The presence of endemic diseases can pose health risks to participants, making it difficult to gather for community dialogues. Concerns about disease transmission may deter people from attending or engaging fully.
Geographic Location: Geographic barriers, such as remote or isolated areas, can hinder accessibility to community dialogues. Limited transportation options and long distances may prevent some community members from attending.
Poor Infrastructure: Inadequate facilities and infrastructure (such as meeting spaces, technology, or communication tools) can impact the feasibility and effectiveness of community dialogues. Lack of proper facilities can hinder participation and communication.

Solutions to the above problems

1. Dialogues are Time Consuming:

Solution: Proper Planning and Clear Objectives Plan the dialogue in advance, setting clear objectives and a structured agenda. Define the scope of discussion and allocate time for each topic to ensure efficient use of time.

2. Poor Preparation and Planning:

Solution: Efficient Communication and Thorough Preparation Communicate with community members prior to the dialogue, sharing the purpose and importance of the discussion. Adequate preparation includes gathering relevant information and materials.

3. Objectors Refusing to Participate:

Solution: Inclusive Engagement and Addressing Concerns Engage objectors individually before the dialogue, addressing their concerns and emphasizing the benefits of their participation. Create an inclusive atmosphere that encourages diverse viewpoints.

4. Lack of Resources:

Solution: Providing Adequate Resources Allocate sufficient resources for venue, materials, refreshments, and transportation if needed. Seek partnerships or sponsorships to ensure resource availability.

5. Too Much Expectation:

Solution: Transparency and Clear Communication Be transparent about the scope and objectives of the dialogue. Clearly communicate what can be achieved through the dialogue and manage expectations accordingly.

6. Lack of Unity and Cooperation:

Solution: Training and Team Building Conduct team-building activities or training sessions to promote unity and cooperation among community members. Highlight the importance of collaboration for effective problem-solving.

7. Hostility of Community Members:

Solution: Establishing Trust and Open Dialogue Build trust through open communication and active listening. Address concerns and conflicts sensitively, fostering a safe environment where community members feel respected and valued.

8. Insecurity and Geographic Location:

Solution: Ensuring Safety and Accessibility Choose a safe and accessible venue for the dialogue. Consider community preferences and concerns related to safety when selecting the location.
Involve community leaders, this helps in mobilization and also identifying people to hold a dialogue.

9. Disease Endemics:

Solution: Health Precautions and Awareness Prioritize health and safety by implementing necessary precautions, such as providing hand sanitizers and following health guidelines. Raise awareness about disease prevention.
Health education and awareness about endemics.

10. Poor Infrastructure:

Solution: Adaptation and Resourcefulness Make use of available resources to improve the dialogue environment. Arrange seating, lighting, and amenities to ensure a comfortable setting despite limited infrastructure.
Lobbying of resources for infrastructure problems.

Community dialogue Read More »

SUSTAINABLE DEVELOPMENT GOALS (SDGS)

Sustainable Development Goals (SDGs), also known as the Global Goals, were adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity.

The 17 SDGs are integrated—they recognize that action in one area will affect outcomes in others, and that development must balance social, economic and environmental sustainability.

NO POVERTY
ZERO HUNGER
GOOD HEALTH AND WELL-BEING
QUALITY EDUCATION
GENDER EQUALITY
CLEAN WATER AND SANITATION
AFFORDABLE AND CLEAN ENERGY
DECENT WORK AND ECONOMIC GROWTH
INDUSTRY, INNOVATION AND INFRASTRUCTURE
REDUCED INEQUALITIES
SUSTAINABLE CITIES AND COMMUNITIES
RESPONSIBLE CONSUMPTION AND PRODUCTION
CLIMATE ACTION
LIFE BELOW WATER
LIFE ON LAND
PEACE, JUSTICE AND STRONG INSTITUTIONS
PARTNERSHIPS FOR THE GOALS

The Sustainable Development Goals (SDGs)

The Sustainable Development Goals (SDGs), also known as the Global Goals, are a universal call to action to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity.

They were adopted by all UN Member States in 2015 as part of the 2030 Agenda for Sustainable Development, which sets out a 15-year plan to achieve the goals. The SDGs build on the success of the Millennium Development Goals (MDGs), but unlike the MDGs, they are universal and apply to all countries, not just developing ones.

Key Characteristics of the SDGs:

17 Goals and 169 Targets: The SDGs are composed of 17 interconnected goals and 169 specific targets.
Universal Applicability: They apply to all countries, rich and poor, emphasizing a shared global responsibility.
Integrated and Indivisible: The goals recognize that ending poverty must go hand-in-hand with strategies that build economic growth and address a range of social needs, while tackling climate change and environmental protection.
Leave No One Behind: A core principle of the SDGs is the commitment to ensure that the most vulnerable and marginalized populations are prioritized.
Partnership: Achieving the goals requires a strong global partnership among governments, the private sector, civil society, and citizens.

The 17 Sustainable Development Goals:

No Poverty : End poverty in all its forms everywhere.
Zero Hunger : End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.
Good Health and Well-being : Ensure healthy lives and promote well-being for all at all ages.
Quality Education : Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.
Gender Equality : Achieve gender equality and empower all women and girls.
Clean Water and Sanitation : Ensure availability and sustainable management of water and sanitation for all.
Affordable and Clean Energy : Ensure access to affordable, reliable, sustainable, and modern energy for all.
Decent Work and Economic Growth : Promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all.
Industry, Innovation, and Infrastructure : Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation.
Reduced Inequalities ↔️: Reduce inequality within and among countries.
Sustainable Cities and Communities : Make cities and human settlements inclusive, safe, resilient, and sustainable.
Responsible Consumption and Production : Ensure sustainable consumption and production patterns.
Climate Action : Take urgent action to combat climate change and its impacts.
Life Below Water : Conserve and sustainably use the oceans, seas, and marine resources for sustainable development.
Life on Land : Protect, restore, and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, halt and reverse land degradation, and halt biodiversity loss.
Peace, Justice, and Strong Institutions : Promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build effective, accountable, and inclusive institutions at all levels.
Partnerships for the Goals: Strengthen the means of implementation and revitalize the global partnership for sustainable development.

Mnemonics for the 17 SDGs

Mnemonic 1: The “We Can Do It” Story

Imagine a scenario where Poor people have No Food get Sick can’t go to School which particularly affects Girls. To fix this, they need Clean Water and Electricity. This leads to Decent Jobs in a new Factory that helps to Reduce Inequality. The factory is in a Sustainable City that practices Responsible Consumption. They also care about the Climate and the Ocean, and they protect the Forest. This peaceful and just city has Good Institutions and a strong Partnership to achieve all of these goals.

Poor (Poverty)
No Food (Zero Hunger)
Sick (Good Health)
School (Quality Education)
Girls (Gender Equality)
Clean Water (Clean Water and Sanitation)
Electricity (Affordable and Clean Energy)
Decent Jobs (Decent Work)
Factory (Industry, Innovation, and Infrastructure)
Reduce Inequality
Sustainable City (Sustainable Cities)
Responsible Consumption
Climate
Ocean (Life Below Water)
Forest (Life on Land)
Good Institutions (Peace, Justice, and Strong Institutions)
Partnership

Mnemonic 2: The “C.H.E.E.S.E.Y” Acronym

This mnemonic divides the goals into a few categories to make them easier to remember.

Poverty & Basic Needs (Goals 1-6):

Poverty & Hunger: No Poverty, Zero Hunger
Health & Education: Good Health, Quality Education
Gender & Water: Gender Equality, Clean Water

Economic & Infrastructural Goals (Goals 7-11):

Energy & Work: Affordable & Clean Energy, Decent Work
Infrastructure & Inequality: Industry, Innovation, & Infrastructure; Reduced Inequalities
Cities: Sustainable Cities and Communities

Environmental & Global Goals (Goals 12-17):

Responsible Consumption: Responsible Consumption and Production
Climate Action: Climate Action
Life Below Water & Life on Land
Peace, Justice, and Strong Institutions
Partnerships for the Goals

Mnemonic 3: The “Simple Sentence” Mnemonic

This is a more direct, sentence-based mnemonic. It’s a bit long, but if you can remember the key words, it can be effective.

People Have Healthy Educated Girls Who Earn Decent Income Reducing Inequality in Sustainable Cities by Conserving Climate, Oceans, and Land, and promoting Peaceful Partnerships.

People (Poverty)
Have (Hunger)
Healthy (Health)
Educated (Education)
Girls (Gender)
Who (Water)
Earn (Energy)
Decent (Decent Work)
Income (Industry)
Reducing (Reduced Inequality)
Sustainable (Sustainable Cities)
Conserving (Consumption)
Climate (Climate Action)
Oceans (Oceans)
Land (Life on Land)
Peaceful (Peace)
Partnerships (Partnerships)

Goal 1: No Poverty

Objective: To eliminate poverty in all its forms globally.

Targets:

By 2030, halve the proportion of individuals, encompassing men, women, and children of all age groups, living in poverty across all dimensions as defined by national standards.
Establish nationally appropriate social protection systems and measures for all citizens, incorporating basic safeguards, with the aim of achieving substantial coverage for the impoverished and vulnerable segments of society by 2030.
Ensure equitable rights to economic resources for all, with special emphasis on the impoverished and vulnerable, guaranteeing access to fundamental services, land ownership, control over property, inheritance, natural resources, suitable innovative technologies, and financial services, including microfinance.
Enhance the resilience of impoverished individuals and those in vulnerable circumstances by 2030, minimizing their susceptibility and exposure to climate-related extreme events and other economic, social, and environmental shocks and disasters.
Mobilize significant resources from diverse origins, including bolstered development cooperation, to ensure adequate and foreseeable means for developing nations, notably the least developed countries, to execute programs and policies addressing multidimensional poverty.
Establish robust policy frameworks at the national, regional, and international levels, grounded in development strategies that prioritize the welfare of the impoverished and are sensitive to gender concerns, to foster increased investment in actions aimed at eradicating poverty.

Goal 2

ZERO HUNGER : End hunger; achieve food security, improved nutrition and promote sustainable agriculture

Goal targets

By 2030, eliminate all manifestations of malnutrition, and achieve internationally agreed-upon benchmarks for reducing stunting and wasting in children under the age of 5 by 2025. Address the nutritional requirements of adolescent girls, pregnant and lactating women, and elderly individuals.
Enhance the agricultural productivity and income of small-scale food producers, particularly women, indigenous communities, family farmers, pastoralists, and fishers. This entails providing secure and equitable access to land, productive resources, knowledge, financial services, markets, opportunities for value addition, and non-farm employment. This should be accomplished by 2030.
Implement sustainable food production systems and adopt resilient agricultural practices that boost productivity and output. These practices should simultaneously uphold ecosystem integrity, enhance adaptive capacity to climate change, extreme weather, drought, flooding, and other disasters, and progressively enhance land and soil quality by 2030.
Safeguard the genetic diversity of seeds, cultivated plants, domesticated animals, and related wild species. This involves maintaining well-managed and diversified seed and plant banks at national, regional, and international levels. Encourage equitable sharing of benefits arising from genetic resource utilization and associated traditional knowledge, adhering to international agreements.
Increase investment, including bolstered international collaboration, in rural infrastructure, agricultural research, extension services, technology development, and seed and livestock gene banks. This will enhance agricultural productive capacity, particularly in developing nations, including the least developed countries.
Rectify and prevent trade constraints and distortions in global agricultural markets, aligned with the Doha Development Round’s mandate. This encompasses the simultaneous elimination of agricultural export subsidies and equivalent measures that distort trade, fostering fair and competitive markets.
Implement measures to ensure the effective functioning of food commodity markets and derivatives, and enable timely access to market information, including data on food reserves. This facilitates curbing extreme food price volatility.

Goal 3

GOOD HEALTH AND WELL-BEING : Good health and well being . ensure healthy lives and promote well being for all at all ages.

Goal targets

By 2030, reduce the global maternal mortality ratio to below 70 per 100,000 live births.
By 2030, eradicate preventable deaths among newborns and children under the age of 5. All nations should strive to lower neonatal mortality to a minimum of 12 per 1,000 live births and under-5 mortality to at least 25 per 1,000 live births.
Eliminate the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases by 2030. Combat hepatitis, water-borne diseases, and other communicable diseases.
By 2030, diminish premature mortality from non-communicable diseases by one third through prevention and treatment. Additionally, promote mental health and overall well-being.
Strengthen the prevention and treatment of substance abuse, including narcotic drug misuse and harmful alcohol consumption.
By 2020, cut in half the global number of deaths and injuries resulting from road traffic accidents.
Ensure universal access to sexual and reproductive health-care services by 2030. This includes family planning, education, and the integration of reproductive health into national strategies and programs.
Achieve universal health coverage encompassing financial risk protection and access to high-quality essential health-care services. Ensure availability of safe, effective, high-quality, and affordable essential medicines and vaccines for all.
By 2030, substantially decrease deaths and illnesses caused by hazardous chemicals, air, water, and soil pollution and contamination.
Enhance the enforcement of the World Health Organization Framework Convention on Tobacco Control in all countries as relevant.
Support research and development of vaccines and medicines targeting communicable and noncommunicable diseases primarily affecting developing nations. Ensure access to affordable essential medicines and vaccines, complying with the Doha Declaration on the TRIPS Agreement and Public Health. This declaration affirms developing countries’ right to employ Trade Related Aspects of Intellectual Property Rights (TRIPS) flexibilities to safeguard public health.
Considerably escalate health financing and bolster the recruitment, development, training, and retention of healthcare professionals in developing countries, particularly in the least developed countries and small island developing States.
Reinforce the preparedness of all nations, especially developing ones, for early warning, risk reduction, and management of national and global health hazards.

Goal 4

QUALITY EDUCATION : Quality education. Ensure inclusive and equitable quality education and promote life long learning opportunities for all.

Goal targets

By 2030, guarantee that all boys and girls successfully complete free, fair, and excellent primary and secondary education, leading to significant and effective learning outcomes aligned with Goal 4.
By 2030, provide every girl and boy access to quality early childhood development, care, and pre-primary education, equipping them for a smooth transition into primary education.
By 2030, ensure unbiased access for both women and men to cost-effective, quality technical, vocational, and tertiary education, encompassing university-level studies.
By 2030, substantially increase the number of young people and adults possessing relevant skills, including technical and vocational competencies, essential for securing employment, decent jobs, and entrepreneurial pursuits.
By 2030, eliminate gender disparities in education and ensure equal access for vulnerable groups, including persons with disabilities, indigenous communities, and children in challenging circumstances, to all educational levels and vocational training.
By 2030, ensure universal literacy and numeracy among youth and a substantial segment of adults, encompassing both men and women.
By 2030, equip all learners with the knowledge and proficiencies essential for advancing sustainable development. This includes education on sustainable development, sustainable lifestyles, human rights, gender equality, promotion of peace and non-violence, global citizenship, and appreciation of cultural diversity and culture’s role in sustainable development.
Develop and enhance education facilities that are sensitive to the needs of children, individuals with disabilities, and diverse genders, providing secure, nonviolent, comprehensive, and effective learning environments for all.
By 2020, significantly augment global scholarship opportunities for enrollment in higher education, especially vocational training, information and communications technology, technical, engineering, and scientific programs in developed and other developing countries. Focus on least developed countries, small island developing states, and African nations.
By 2030, substantially increase the supply of qualified educators, fostering international cooperation for teacher training in developing countries, with particular emphasis on the least developed nations.

Goal 5

GENDER EQUALITY : Gender equality; achieve gender equality and empower all women and girls.

Goal targets

Eradicate all forms of discrimination against women and girls, irrespective of their location.
Eradicate all types of violence targeting women and girls in both public and private domains, including trafficking, sexual exploitation, and other forms of abuse.
Eliminate harmful practices such as child, early, and forced marriage, as well as female genital mutilation.
Acknowledge and value unpaid care and domestic labor. This involves offering public services, infrastructure, social protection policies, and encouraging shared responsibility within households and families as appropriate on a national level.
Guarantee full and effective participation for women and equal leadership opportunities across all tiers of decision-making in political, economic, and public spheres.
Ensure universal access to sexual and reproductive health services, including reproductive rights, as outlined by the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action, along with the outcomes of their review conferences.
Implement reforms to establish equitable rights for women to economic resources, including land ownership, control over property, financial services, inheritance, and natural resources, in line with national laws.
Enhance the utilization of enabling technology, particularly information and communications technology, to facilitate the empowerment of women.
Establish and reinforce effective policies and enforceable legislation to promote gender equality and the empowerment of all women and girls across all levels.

Goal 6

CLEAN WATER AND SANITATION : Clean water and sanitation; ensure availability and sustainable management of water and sanitation for all.

Goal targets

By 2030, establish universal and fair access to safe and affordable drinking water for all.
By 2030, achieve access to sufficient and just sanitation and hygiene facilities for everyone, ending open defecation, with particular emphasis on addressing the requirements of women, girls, and those in vulnerable circumstances.
By 2030, enhance water quality by reducing pollution, eliminating improper waste disposal, and minimizing the release of hazardous chemicals and materials. Halve the proportion of untreated wastewater and significantly increase global recycling and safe reuse practices.
By 2030, substantially improve water-use efficiency across all sectors. Ensure sustainable withdrawals and supply of freshwater to address water scarcity, significantly diminishing the number of people affected by water scarcity.
By 2030, implement integrated water resources management at every level, incorporating transboundary cooperation as relevant.
By 2020, safeguard and restore water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers, and lakes.
By 2030, amplify international collaboration and capacity-building assistance for developing nations in water- and sanitation-related endeavors and programs. This includes water harvesting, desalination, water efficiency, wastewater treatment, and recycling and reuse technologies.
Promote and strengthen the participation of local communities in enhancing water and sanitation management.

Goal 7

AFFORDABLE AND CLEAN ENERGY : Affordable and clean energy ensure access to affordable ,reliable, sustainable and modern energy for all.

Goal targets

By 2030, guarantee universal access to energy services that are affordable, reliable, and modern.
By 2030, significantly elevate the proportion of renewable energy within the global energy portfolio.
By 2030, double the global pace of advancement in energy efficiency.
By 2030, foster international collaboration to streamline access to research and technology for clean energy, including renewables, energy efficiency, and advanced, cleaner fossil-fuel technologies. Also, encourage investments in energy infrastructure and clean energy technology.
By 2030, enhance infrastructure and modernize technology to facilitate the provision of sustainable and contemporary energy services for all developing nations, particularly least developed countries, small island developing states, and land-locked developing countries.

Goal 8

DECENT WORK AND ECONOMIC GROWTH : Descent work and economic growth; promote sustainable economic growth and descent work for all .

Goal targets

Sustain per capita economic growth in alignment with national circumstances, striving for a minimum of 7 percent annual gross domestic product growth in the least developed countries.
Attain heightened levels of economic productivity through diversification, technological advancement, and innovation. Emphasis should be placed on high-value added and labor-intensive sectors.
Advocate for development-focused policies that bolster productive activities, generate decent job opportunities, foster entrepreneurship, creativity, and innovation, and encourage the formalization and expansion of micro-, small-, and medium-sized enterprises, including facilitating access to financial services.
Enhance global resource efficiency in consumption and production progressively until 2030. Endeavor to decouple economic growth from environmental degradation, adhering to the 10-year framework of programs on sustainable consumption and production, with developed nations leading the effort.
By 2030, realize full and productive employment and decent work for all individuals, irrespective of gender, including young people and persons with disabilities. Ensure equal pay for work of equal value.
By 2020, significantly decrease the proportion of youth who are not engaged in employment, education, or training.
Take immediate and effective actions to eradicate forced labor, terminate modern slavery and human trafficking, and ensure the prohibition and elimination of the worst forms of child labor, including the recruitment and utilization of child soldiers. Aim to end child labor in all manifestations by 2025.
Safeguard labor rights and foster secure and safe working environments for all workers, encompassing migrant workers, particularly women migrants, and those in precarious employment.
By 2030, formulate and implement policies to advance sustainable tourism that generates employment, and promotes local culture and products.
Strengthen the capacity of domestic financial institutions to enhance access to banking, insurance, and financial services for all segments of society.
Amplify Aid for Trade support for developing countries, notably least developed nations, including through the Enhanced Integrated Framework for Trade-Related Technical Assistance to Least Developed Countries.
By 2020, devise and operationalize a global strategy for youth employment and implement the Global Jobs Pact of the International Labour Organization.

Goal 9

INDUSTRY, INNOVATION AND INFRASTRUCTUR : Industry innovation and infrastructure; build resilient infrastructure, promote sustainable industrialization and foster innovation.

Goal targets

Develop resilient, reliable, sustainable, and high-quality infrastructure, including regional and transboundary facilities. This infrastructure should facilitate economic development and enhance human well-being, particularly focusing on affordable and equal access for all.
Promote inclusive and sustainable industrialization, aiming to significantly raise the industry’s contribution to employment and gross domestic product by 2030. This should align with national circumstances and double its share in least developed countries.
Improve access to financial services, including affordable credit, for small-scale industrial and other enterprises, particularly in developing countries. Facilitate their integration into value chains and markets.
By 2030, upgrade infrastructure and retrofit industries to ensure sustainability. This entails greater resource-use efficiency, increased adoption of clean and environmentally friendly technologies and industrial processes, with all countries taking appropriate actions based on their capabilities.
Enhance scientific research and bolster technological capabilities in industrial sectors worldwide, especially in developing countries. By 2030, encourage innovation and substantially increase the number of research and development workers per 1 million people, along with public and private research and development expenditures.
Strengthen the development of sustainable and resilient infrastructure in developing countries through enhanced financial, technological, and technical support. This support should be extended to African countries, least developed nations, landlocked developing countries, and small island developing states.
Foster domestic technology development, research, and innovation in developing countries. Create an enabling policy environment to encourage industrial diversification and value addition to commodities, among other goals.
Markedly increase access to information and communications technology, striving to provide universal and affordable internet access in least developed countries by 2020.

Goal 10

REDUCED INEQUALITIES : Reduced inequalities within and among countries.

Goal targets

By 2030, progressively achieve and maintain income growth for the bottom 40 percent of the population at a rate surpassing the national average.
By 2030, empower and advocate for the social, economic, and political inclusion of all individuals, regardless of age, gender, disability, race, ethnicity, origin, religion, or economic or other status.
Ensure equal opportunities and diminish disparities in outcomes. This involves eradicating discriminatory laws, policies, and practices, and endorsing pertinent legislation, policies, and actions for this purpose.
Implement policies, especially those pertaining to fiscal matters, wages, and social protection, to progressively achieve greater equality.
Enhance the regulation and oversight of global financial markets and institutions and reinforce the enforcement of these regulations.
Secure amplified representation and voice for developing nations in the decision-making processes of global international economic and financial institutions. This will result in more effective, accountable, legitimate, and credible institutions.
Facilitate organized, secure, regular, and responsible migration and mobility of individuals, including through the execution of planned and well-managed migration policies.
Execute the principle of special and differential treatment for developing countries, notably least developed nations, in accordance with World Trade Organization agreements.
Encourage official development assistance and financial inflows, including foreign direct investment, to states with the greatest need. Focus on least developed countries, African nations, small island developing states, and landlocked developing countries, aligning with their national plans and programs.
By 2030, diminish the transaction costs of migrant remittances to less than 3 percent and eliminate remittance corridors with costs exceeding 5 percent.

Goal 11

SUSTAINABLE CITIES AND COMMUNITIES : Sustainable cities and communities; make cities and human settlements safe, resilient and sustainable.

Goal targets

By 2030, ensure that everyone has access to suitable, secure, and affordable housing and fundamental services, and upgrade informal settlements.
By 2030, establish access for all to safe, affordable, accessible, and sustainable transport systems, with a focus on expanding public transportation. Improve road safety, especially considering the needs of vulnerable populations such as women, children, persons with disabilities, and older individuals.
By 2030, enhance inclusive and sustainable urbanization. Develop the capacity for participatory, integrated, and sustainable planning and management of human settlements across all nations.
Intensify efforts to safeguard and protect the world’s cultural and natural heritage.
By 2030, substantially reduce the number of fatalities and individuals affected, as well as significantly decrease the direct economic losses relative to global gross domestic product caused by disasters, including water-related incidents. Prioritize the protection of those in impoverished and vulnerable situations.
By 2030, decrease the negative per capita environmental impact of cities, giving special attention to air quality and the management of municipal and other types of waste.
Ensure universal access by 2030 to safe, inclusive, accessible, green, and public spaces, particularly catering to women, children, older individuals, and persons with disabilities.
Strengthen positive economic, social, and environmental ties between urban, peri-urban, and rural areas. This can be accomplished by enhancing national and regional development planning.
By 2030, substantially increase the number of cities and human settlements adopting and implementing integrated policies and plans that promote inclusion, resource efficiency, climate change mitigation and adaptation, disaster resilience, and holistic disaster risk management at all levels, in line with the Sendai Framework for Disaster Risk Reduction 2015-2030.
Provide support, including financial and technical assistance, to least developed countries in constructing sustainable and resilient buildings using local materials.

Goal 12

RESPONSIBLE CONSUMPTION AND PRODUCTION : Responsible consumption and production ; ensure sustainable consumption and production patterns.

Goal targets

Implement the 10-year framework of programs for sustainable consumption and production. All countries should take action, with developed nations leading, while considering the capabilities and development of developing countries.
By 2030, accomplish the sustainable management and efficient utilization of natural resources.
By 2030, cut global per capita food waste by half at the retail and consumer levels, and decrease food losses along production and supply chains, including post-harvest losses.
By 2020, achieve environmentally sound management of chemicals and all waste across their entire lifecycle, following established international frameworks. Significantly curtail their release into air, water, and soil to minimize their adverse impacts on human health and the environment.
By 2030, significantly diminish waste generation through preventive measures, reduction, recycling, and reuse.
Encourage companies, particularly large and transnational ones, to adopt sustainable practices and incorporate sustainability information into their reporting cycles.
Promote sustainable public procurement practices, aligned with national policies and priorities.
By 2030, ensure widespread access to pertinent information and awareness for sustainable development and lifestyles in harmony with nature.
Aid developing countries in enhancing their scientific and technological capacity to transition towards more sustainable consumption and production patterns.
Create and implement tools to monitor the sustainable development effects of sustainable tourism, which generates employment and promotes local culture and products.
Streamline inefficient fossil-fuel subsidies that encourage wasteful consumption by rectifying market distortions. This can be achieved through taxation restructuring and gradually phasing out detrimental subsidies, reflecting their environmental impacts, and fully considering the specific requirements and situations of developing countries. This approach should minimize potential adverse consequences on their development while safeguarding the interests of the poor and affected communities.

Goal 13

CLIMATE ACTION : Climate action; to take urgent action to combat climate change and its impacts (hazards).

Goal targets

Enhance resilience and adaptive capacity to climate-related hazards and natural disasters in all nations.
Embed climate change measures into national policies, strategies, and planning efforts.
Enhance education, raise awareness, and bolster human and institutional capabilities regarding climate change mitigation, adaptation, reduction of impacts, and early warning systems.
Implement the commitment made by developed-country parties under the United Nations Framework Convention on Climate Change to jointly mobilize $100 billion annually by 2020 from all sources. This financial support aims to address the needs of developing countries within the context of meaningful mitigation actions and transparent implementation. It also involves fully operationalizing the Green Climate Fund through its capitalization as promptly as possible.
Promote mechanisms for enhancing effective climate change-related planning and management capabilities in least developed countries and small island developing states. Emphasis should be placed on women, youth, and local and marginalized communities.

Goal 14

LIFE BELOW WATER : To conserve oceans, seas, and marine resources for sustainable development.

Goal targets

By 2025, prevent and substantially reduce marine pollution of all kinds, particularly from land-based activities, including marine debris and nutrient pollution.
By 2020, implement sustainable management and protection of marine and coastal ecosystems to avoid significant adverse impacts. Strengthen their resilience and take restorative actions to ensure healthy and productive oceans.
Minimize and address the effects of ocean acidification through enhanced scientific cooperation at all levels.
By 2020, establish effective regulations for harvesting and halt overfishing, illegal, unreported, and unregulated fishing, as well as destructive fishing practices. Implement science-based management plans to restore fish stocks to levels that can yield maximum sustainable output as determined by their biological characteristics.
By 2020, safeguard a minimum of 10 percent of coastal and marine areas, consistent with national and international law and informed by the best available scientific knowledge.
By 2020, prohibit specific forms of fisheries subsidies contributing to overcapacity and overfishing. Eliminate subsidies contributing to illegal, unreported, and unregulated fishing and avoid introducing new such subsidies. Acknowledge the necessity of appropriate and effective special and differential treatment for developing and least developed countries as integral to World Trade Organization fisheries subsidies negotiations.
By 2030, enhance economic benefits to Small Island Developing States and least developed countries through the sustainable use of marine resources. This involves sustainable management of fisheries, aquaculture, and tourism.
Amplify scientific knowledge, cultivate research capacity, and facilitate the transfer of marine technology, guided by the Intergovernmental Oceanographic Commission Criteria and Guidelines on the Transfer of Marine Technology. This will enhance ocean health and contribute to the development of developing countries, particularly Small Island Developing States and least developed countries.
Grant small-scale artisanal fishers access to marine resources and markets.
Reinforce the conservation and sustainable utilization of oceans and their resources by implementing international law as reflected in the United Nations Convention on the Law of the Sea (UNCLOS), which furnishes the legal framework for conserving and sustainably utilizing oceans and their resources, as reiterated in paragraph 158 of “The Future We Want.”

Goal 15

LIFE ON LAND : To protect, restore and promote sustainable use of eco systems, manage forests combat the desertification, halt- land degradation and biodiversity.

Goal targets

By 2020, ensure the preservation, restoration, and sustainable utilization of terrestrial and inland freshwater ecosystems and their services. This encompasses forests, wetlands, mountains, and drylands, in alignment with commitments under international agreements.
By 2020, promote the adoption of sustainable management practices for all forest types. Halt deforestation, rehabilitate degraded forests, and significantly amplify afforestation and reforestation efforts worldwide.
By 2030, counter desertification, rehabilitate degraded land and soil (including land affected by desertification, drought, and floods), and strive to achieve a world where land degradation is balanced through restoration efforts.
By 2030, safeguard mountain ecosystems and their biodiversity to enhance their ability to furnish crucial benefits for sustainable development.
Take immediate, substantial measures to mitigate natural habitat degradation, halt biodiversity loss, and, by 2020, protect and avert the extinction of endangered species.
Foster equitable and fair sharing of benefits derived from the use of genetic resources. Facilitate appropriate access to these resources in accordance with international agreements.
Swiftly address the poaching and illegal trade of protected flora and fauna species. Tackle both the supply and demand of illegal wildlife products.
By 2020, institute strategies to thwart the introduction and significantly reduce the impact of invasive alien species on terrestrial and aquatic ecosystems. Undertake measures to control or eradicate priority species.
By 2020, integrate ecosystem and biodiversity values into national and local planning, development processes, poverty reduction strategies, and accounts.

Goal 16

PEACE, JUSTICE AND STRONG INSTITUTIONS : Peace, justice and strong institution; to promote peaceful societies for sustainable development , provide access to justice for all and build effective, accountable and institution at all levels.

Goal targets

Substantially diminish all forms of violence and associated mortality rates universally.
Terminate the mistreatment, exploitation, trafficking, and all varieties of violence, as well as torture of children.
Foster the rule of law both nationally and internationally, guaranteeing equitable access to justice for all.
By 2030, significantly reduce the illicit flow of finances and arms. Strengthen the retrieval and repatriation of stolen assets and combat all manifestations of organized crime.
Drastically decrease corruption and bribery in all their manifestations.
Cultivate efficient, accountable, and transparent institutions at every level.
Ensure that decision-making processes are responsive, inclusive, participatory, and representative at all levels.
Enhance the engagement of developing countries in global governance institutions.
By 2030, provide legal identity to all individuals, including birth registration.
Assure public access to information and safeguard fundamental freedoms, in alignment with domestic laws and international agreements.

Goal 17

PARTNERSHIPS FOR THE GOALS : To strengthen the means of implementation for sustainable development.

Goal targets

Finance:
- Enhance domestic resource mobilization, including international assistance to bolster tax and revenue collection capacity in developing countries.
- Fully implement official development assistance (ODA) commitments by developed countries, including the goal of 0.7% of ODA/GNI to developing countries and 0.15% to 0.20% of ODA/GNI to least developed countries. Consider setting a target of at least 0.20% of ODA/GNI to least developed countries.
- Mobilize additional financial resources for developing countries from diverse sources.
- Assist developing countries in achieving sustainable long-term debt through coordinated policies promoting debt financing, relief, and restructuring. Address external debt of highly indebted poor countries to alleviate debt distress.
- Adopt and execute investment promotion frameworks for least developed countries.
Technology:
- Strengthen North-South, South-South, and triangular cooperation for access to science, technology, and innovation. Enhance knowledge sharing with agreed terms through improved coordination, especially at the United Nations level, and establish a global technology facilitation mechanism.
- Promote development, transfer, dissemination, and diffusion of environmentally sound technologies to developing countries under favorable terms, including concessional and preferential terms.
- Fully operationalize the technology bank and science, technology, and innovation capacity-building mechanism for least developed countries by 2017. Increase utilization of enabling technology, particularly information and communications technology.
Capacity Building:
- Enhance international support for effective and focused capacity building in developing countries. This aids in implementing national plans for achieving all sustainable development goals, utilizing North-South, South-South, and triangular cooperation.
Trade:
- Advocate for a universal, rules-based, open, non-discriminatory, and fair multilateral trading system under the World Trade Organization. Conclude negotiations under the Doha Development Agenda to achieve this.
- Substantially boost exports from developing countries, striving to double the share of global exports from least developed countries by 2020.
- Achieve enduring duty-free and quota-free market access for all least developed countries. This involves transparent and straightforward preferential rules of origin for imports from least developed countries that facilitate market access.
Systemic Issues:
- Enhance global macroeconomic stability through policy coordination and coherence.
- Foster policy coherence for sustainable development.
- Acknowledge each country’s policy space and leadership to formulate and execute policies for poverty eradication and sustainable development.
Multi-Stakeholder Partnerships:
- Fortify the global partnership for sustainable development, supported by multi-stakeholder partnerships. These partnerships mobilize and share knowledge, expertise, technology, and financial resources to aid all countries, particularly developing ones, in achieving the sustainable development goals.
- Promote effective public, public-private, and civil society partnerships, drawing from partnership experiences and resourcing strategies.
Data, Monitoring, and Accountability:
- By 2020, amplify capacity-building support for developing countries, including least developed countries and small island developing States. The goal is to significantly enhance the availability of high-quality, timely, and reliable data disaggregated by various characteristics.
- By 2030, build upon existing initiatives to develop supplementary progress measurements for sustainable development alongside gross domestic product. Also, facilitate statistical capacity-building in developing countries.

SUSTAINABLE DEVELOPMENT GOALS (SDGS) Read More »

FEMALE EXTERNAL GENITAL ORGANS

FEMALE EXTERNAL GENITAL
ORGANS

Female external genitalia (the vulva) include the mons pubis, labia majora, labia minora, clitoris, vestibule, the greater vestibular glands (Bartholin’s glands) and bulbs of the vestibule

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• The mons pubis is a rounded pad of fat lying anterior to the symphysis pubis. It is covered with pubic hair from the time of puberty.
• The labia majora (‘greater lips’) are two folds of fat and areolar tissue which are covered with skin and pubic hair on the outer surface and have a pink, smooth inner surface.
• The labia minora (‘lesser lips’) are two small subcutaneous folds, devoid of fat, that lie between the labia majora. Anteriorly, each labium minus divides into two parts: the upper layer passes above the clitoris to form along with its fellow a fold, the prepuce, which overhangs the clitoris. The prepuce is a retractable piece of skin which surrounds and protects the clitoris. The lower layer passes below the clitoris to form with its fellow the frenulum of the clitoris.
• The clitoris is a small rudimentary sexual organ corresponding to the male penis. The visible knob-like portion is located near the anterior junction of the labia minora, above the opening of the urethra and vagina. Unlike the penis, the clitoris does not contain the distal portion of the urethra and functions solely to induce the orgasm during sexual intercourse.
• The vestibule is the area enclosed by the labia minora in which the openings of the urethra and the vagina are situated.
• The urethral orifice lies 2.5 cm posterior to the clitoris and immediately in front of the vaginal orifice. On either side lie the openings of the Skene’s ducts, two small blind-ended tubules 0.5 cm long running within the urethral wall.
• The vaginal orifice, also known as the introitus of the vagina, occupies the posterior two-thirds of the vestibule. The orifice is partially closed by the hymen, a thin membrane that tears during sexual intercourse. The remaining tags of hymen are known as the ‘carunculae myrtiformes’ because they are thought to resemble myrtle berries.
• The greater vestibular glands (Bartholin’s glands) are two small glands that open on either side of the vaginal orifice and lie in the posterior part of the labia majora. They secrete mucus, which lubricates the vaginal opening. The duct may occasionally become blocked, which can cause the secretions from the gland to accommodate within it and form a cyst.
• The bulbs of the vestibule are two elongated erectile masses flanking the vaginal orifice.
Blood supply
The blood supply comes from the internal and the external pudendal arteries. The blood drains through corresponding veins.
Lymphatic drainage
Lymphatic drainage is mainly via the inguinal glands.
Innervation
The nerve supply is derived from branches of the pudendal nerve.

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THE PERINEUM

The perineum corresponds to the pelvis outlet, forming a somewhat lozenge-shaped area. It is bordered anteriorly by the pubic arch, posteriorly by the coccyx, and laterally by the ischiopubic rami, ischial tuberosities, and sacrotuberous ligaments.

A transverse line drawn between the ischial tuberosities divides the perineum into two triangular portions. The anterior triangle, housing the external urogenital organs, is referred to as the urogenital triangle, while the posterior triangle, encompassing the termination of the anal canal, is known as the anal triangle.

The Urogenital Triangle: The urogenital triangle is bounded anteriorly and laterally by the pubic symphysis and the ischiopubic rami. It comprises two compartments: the superficial and deep perineal spaces, separated by the perineal membrane that spans between the ischiopubic rami. The levator ani muscles attach to the cranial surface of this membrane. The vestibular bulb and clitoral crus are fused with the caudal surface of the membrane, covered by the bulbospongiosus and ischiocavernosus muscles.

Superficial Muscles of the Perineum: Superficial Transverse Perineal Muscle: Arising from the inner and forepart of the ischial tuberosity, the superficial transverse muscle is a narrow slip of muscle inserted into the central tendinous part of the perineal body. It connects with the external anal sphincter (EAS) from behind and the bulbospongiosus in the front, all attaching to the central tendon of the perineal body.

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Bulbospongiosus Muscle: Running along each side of the vaginal orifice, the bulbospongiosus muscle covers the lateral aspects of the vestibular bulb anteriorly and Bartholin’s gland posteriorly. Some fibers merge with the superficial transverse perineal muscle and the EAS in the central fibromuscular perineal body. Anteriorly, its fibers extend around the vagina and insert into the corpora cavernosa clitoridis, compressing the deep dorsal vein. This muscle contributes to clitoral erection and narrows the vaginal orifice.

Ischiocavernosus Muscle: Situated on the lateral boundary of the perineum, the ischiocavernosus muscle is elongated, broader at its middle, and arises from the inner surface of the ischial tuberosity, crus clitoridis, and adjacent portions of the ischial ramus.

Innervation: Nerve supply is provided by branches of the pudendal nerve.

PELVIC FLOOR MUSCLES

Pelvic floor is a muscular partition which separates the pelvic cavity from the anatomical perineum.

It consists of three sets of muscles on either side—pubococcygeus, iliococcygeus and ischiococcygeus and these are collectively called levator ani.

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Its upper surface is concave and slopes downwards, backwards and medially and is covered by parietal layer of pelvic fascia. The inferior surface is convex and is covered by anal fascia. The muscle with the covering fascia is called the pelvic diaphragm/pelvic floor.

ORIGIN: Each levator ani arises from the back of the pubic rami, from the condensed fascia covering the obturator internus (white line) and from the inner surface of the ischial spine.
INSERTION: From this extensive origin, the fibers pass, backwards and medially to be inserted in the midline from before backwards to the vagina (lateral and posterior walls), perineal body and anococcygeal raphe, lateral borders of the coccyx and lower part of the sacrum (Fig. 1.10)

The muscles of the levator ani exhibit distinctive characteristics compared to most other skeletal muscles. These include:

Sustaining continuous tone, except during activities like voiding, defecation, and the Valsalva maneuver.
Demonstrating the capability to contract rapidly during moments of acute stress, such as coughing or sneezing, to uphold continence.
Significantly expanding during childbirth to accommodate the passage of a full-term infant, followed by contracting after delivery to return to regular function.

THE PUDENDAL NERVE

The pudendal nerve serves as a mixed motor and sensory nerve, drawing fibers from the ventral branches of the second, third, and fourth sacral nerves. Exiting the pelvis through the lower portion of the greater sciatic foramen, it traverses the ischial spine and reenters the pelvis via the lesser sciatic foramen. Progressing alongside the internal pudendal vessels, it courses upward and forward along the lateral wall of the ischioanal fossa within a protective sheath of the obturator fascia termed Alcock’s canal (Fig. 3.7). Notably, during an extended second stage of labor, the pudendal nerve is susceptible to stretch injury at this site due to its limited mobility.

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From the pudendal nerve\’s posterior extension, the inferior haemorrhoidal (rectal) nerve diverges to innervate the external anal sphincter (EAS). Further division yields two terminal branches: the perineal nerve and the dorsal nerve of the clitoris. The perineal nerve subsequently splits into posterior labial and muscular branches. The posterior labial branches supply the labia majora, while the muscular branches distribute to the superficial transverse perineal, bulbospongiosus, ischiocavernosus, and constrictor urethrae muscles. The dorsal nerve of the clitoris, the nerve deepest within the pudendal division, innervates the clitoris itself.

FEMALE EXTERNAL GENITAL ORGANS Read More »

INJECTION SAFETY AND MANAGEMENT

INJECTION SAFETY AND MANAGEMENT INTRODUCTION

Injection, or Getting an injection is a very common medical procedure. Most injections, about 95%, are given to treat illnesses. Immunizations make up about 3% of all injections, and the rest are used for different reasons, like giving blood or contraceptives.

A Problem to Solve: In many countries that are still developing or going through changes, a lot of injections are given when they’re not really needed. Sometimes, as many as 9 out of 10 people who go to see a primary health care provider get an injection. But more than 70% of these injections aren’t necessary. They could be given as medicine you swallow instead.

What’s Important: After an injection, it’s really important to safely collect and get rid of the used needles and syringes. This is a big part of how injections are taken care of from start to finish.

Three Big Concerns: When we think about whether injections are safe, there are three important things to consider:

The person getting the injection should be safe.
The health worker giving the injection should be safe.
The community where the injections are happening should be safe.

So, making sure injections are done safely is really important for everyone’s well-being.

Injection Safety Guidelines

According to the World Health Organization (WHO, 2005), a safe injection is one that doesn’t harm the person receiving it, doesn’t put the person giving the injection at unnecessary risk, and doesn’t create dangerous waste for the community.

Principles to Follow for Safe Injections:

Always use a new syringe and needle for each vaccine.
Keep injection equipment and vaccine clean to avoid contamination.
Prepare injections in a clean area where there’s little chance of contamination from blood or body fluids.
Use a clean, sterile needle to puncture the top of multi-dose vials.
Don’t leave the needle in the stopper of the vial.
Protect your fingers with a small gauze pad when opening ampoules.
Throw away a needle that touches anything not sterile, like your hands or surfaces.
Be ready for any sudden movements from the patient during and after the injection.
To avoid getting hurt, don’t put the cap back on a used needle; put it straight into a safety box.
Put used syringes and needles into a safety box right where you used them, and seal the box when it’s full. Don’t move the contents or overfill the boxes.
Close and seal the safety boxes before taking them to a safe place. Don’t open, empty, or reuse them.
Handle and dispose of injection waste in a way that’s safe for the environment.
Prevent accidents for the people in charge of throwing away the waste.
Don’t put empty vials in the safety box; they might burst when burned.
Only put potentially contaminated injection equipment in the safety boxes. Don’t put empty vials, cotton pads, or other things in them.

Guidelines for Safe Injections:

Follow the right infection control practices and keep everything clean when preparing and giving injections.
Don’t use the same syringe for different patients, even if you change the needle or inject through a tube.
Never put a used needle or syringe into a vial.
Don’t use medications meant for one use on more than one patient.
Don’t use a bag of IV solution for more than one patient.
Use multi-dose vials for one patient if possible.
Don’t keep multi-dose vials near where you treat patients. Prepare medications in a clean area away from any contamination, and not where you handle used syringes.
Wear a facemask when injecting material or placing a catheter into the epidural or subdural space.

Ways to Prevent Unsafe Injections:

Teach health care workers about injection safety.
Supervise health workers when they give medicines.
Set up rules and regulations to make sure injections are safe.
Hire qualified health workers.
Supervise intern nurses when they give medicines.

Prevent Needle Pricks

Use Safety Needles: Choose needles with safety features like retractable or shielded needles. These devices automatically cover the needle after use, reducing the risk of accidental pricks.
Follow Proper Handling: Handle needles with care and avoid recapping after use. Dispose of them immediately in designated sharps containers.
Wear Personal Protective Equipment (PPE): Always wear gloves when handling needles or coming into contact with blood or body fluids. Use other appropriate PPE as needed.
Safe Disposal: Properly dispose of used needles and sharps in puncture-resistant containers. Ensure containers are close to where procedures are performed.
Use Needleless Systems: Employ needleless systems whenever possible for medication preparation and administration, reducing the need for needles.
Adopt Engineering Controls: Install safety-engineered devices and equipment that minimize the risk of needle pricks during procedures.
Education and Training: Provide thorough training on proper needle handling, disposal, and safety protocols to all healthcare workers.
Sharps Injury Prevention Program: Establish a program that identifies risks, offers guidance, and encourages reporting of any needle prick incidents.
Safe Practices for Disposal: Train staff to properly close and seal sharps containers when they’re full. Arrange for regular disposal and replacement of containers.
Sharps Containers Accessibility: Place sharps containers at convenient locations throughout the facility to encourage proper disposal.
Post-Procedure Safety: After using needles, avoid hurriedly disposing of equipment. Take time to ensure proper disposal and safety measures.
Communication and Collaboration: Encourage open communication among healthcare team members about needle safety and potential risks.
Needleless Catheters: Use needleless catheter systems for intravenous access to minimize needle use and related risks.
Safety Syringes: Implement safety syringes with features that reduce the risk of needle pricks during injection or withdrawal.
Regular Review and Updates: Continuously assess and update needle safety protocols based on new technologies and best practices.

Managing an Accidental Needle Prick.

Accidental needle pricks can happen, but knowing how to handle them properly is crucial. Here are the steps to manage an accidental needle prick:

Stay Calm: Take a deep breath and try to stay calm. Accidents can happen, but you can take steps to minimize any potential harm.
Allow Bleeding: If the needlestick causes a small cut or puncture, gently squeeze the area to encourage bleeding. This can help flush out any potential germs.
Wash the Area: Clean the affected area with soap and running water. Thoroughly wash the wound for at least 20 seconds.
Inform Your Supervisor: Let your immediate supervisor or instructor know about the incident as soon as possible. They can guide you through the proper procedures and documentation.
Report to Occupational Health: Visit your institution’s occupational health department or designated medical personnel. They will assess the risk and guide you on any necessary actions.
Identify the Source: If possible, identify the source patient (the person whose blood you were exposed to). This is important for assessing potential infections and taking appropriate measures.
Collect Information: Note down important details, such as the type of exposure, the circumstances, and any information about the source patient.
Testing and Treatment: Depending on the situation, you may need to undergo blood tests to check for infections like HIV, hepatitis B, and hepatitis C. Your healthcare provider will determine if post-exposure prophylaxis (PEP) is necessary.
Follow Medical Recommendations: If PEP or any other treatment is prescribed, make sure to follow the instructions carefully. PEP is most effective when started as soon as possible after exposure.
Document the Incident: Keep a record of the incident, including dates, times, actions taken, and any medical treatments received. This documentation is important for your own records and any future follow-up.

Disposal criteria in mass immunization

Methods	Strengths	Weaknesses
Waste burial pit/cement encapsulation or other immobilizing agent (sand, plaster)	❒ Simple ❒ Inexpensive ❒ Low tech ❒ Prevents unsafe needle and syringe reuse ❒ Prevents sharp-related infections/injuries to waste handlers/scavengers	❒ Potential of being unburied (if pit is only soil-covered and waste not encapsulated) ❒ No volume reduction ❒ No disinfection of wastes ❒ Pit fills quickly during campaigns ❒ Not recommended for non-sharp infectious wastes ❒ Danger to the community if not properly buried ❒ Inappropriate in areas of heavy rain or if water table is near the surface
Burning (<400°C)	❒ Relatively inexpensive ❒ Reduction in waste volume ❒ Reduction in infectious material	❒ Incomplete combustion ❒ May not completely sterilize ❒ Heavy smoke & potential fire hazard ❒ Requires fuel, dry waste to start burning ❒ Toxic air emissions (e.g., heavy metals, dioxins, furans, fly ash) which may violate environmental or health regulations ❒ Production of hazardous ash containing leachable metals, dioxins, and furans ❒ Potential for needlestick injuries since needles are not destroyed
Medium Temp Incineration (800°-1000°C)	❒ Less expensive than high-temperature incinerators ❒ Reduction in waste volume ❒ Reduction in infectious material	❒ Incomplete combustion ❒ Potential for heavy smoke ❒ Requires fuel and dry waste for start-up and maintenance of high temperatures ❒ Trained personnel needed to operate ❒ Potential emission of toxic air pollutants to a low level (e.g., heavy metals, dioxins, furans, fly ash) which may violate environmental or health regulations ❒ Production of hazardous ash containing variable leachable metals, dioxins, and furans ❒ Potential for needle stick injuries since some needles may not be destroyed ❒ Needs constant attention during operation and regular maintenance throughout the year
High Temp Incineration (>1000°C)	❒ Almost complete combustion and sterilization of used injection equipment ❒ Further reduces toxic emissions with pollution control devices ❒ Greatly reduces volume of immunization waste	❒ Expensive to build, operate, and maintain ❒ Requires electricity, fuel, and trained personnel to operate ❒ Toxic air emissions (e.g., metals, dioxins, furans, fly ash) may still be released without pollution control devices ❒ May produce hazardous ash containing variable leachable metals, dioxins, and furans
Needle removal/needle destruction (Models range from simple manual and battery operated to more complex electrical units)	❒ Prevents needle reuse ❒ Reduces occupational risks to waste handlers and scavengers ❒ In some instances, plastic may be recycled after treatment ❒ Manual/battery-operated models available	❒ Fluid splashes may contaminate work area/operator ❒ Fluid splash back and needle manipulation may lead to disease transmission in some cases ❒ Used needles/syringes need further treatment for disposal in some cases ❒ Safety profile not established
Melting syringes	❒ Greatly reduces volume of immunization waste ❒ Prevents reuse ❒ Safety profile not established	❒ Emission of potentially toxic gases ❒ Electricity required
Steam sterilization (autoclaving or hydro claving), microwaving (with shredding)	❒ Successfully used for decades to treat sharps and non-immunization healthcare wastes ❒ Range of models and capacities available ❒ Sterilizes used injection equipment ❒ Less hazardous air emissions (no dioxins or heavy metals) ❒ Reduced waste volume when used with shredder ❒ Plastic may be recycled after separation	❒ High capital cost (but may be less than high-temperature incinerators with pollution control devices) ❒ Requires electricity and water ❒ High operational costs ❒ High maintenance ❒ May emit volatile organics in steam during depressurization and chamber opening ❒ Requires further treatment to avoid reuse (e.g., shredding) ❒ Resulting sterile waste still needs proper disposal

Injection misuse and overuse (Using Injections Safely and Responsibly)

Sometimes, injections are not used in the right way, and that can cause problems. Let’s understand why this happens and what can be done to prevent it.

Why Injections are Misused and Overused:

People might think injections are stronger and faster, so they prefer them.
Some believe that doctors think injections are the best treatment.
Doctors might give more injections because they want to make patients happy.
Also, doctors can charge more money for injections, so they might prescribe them even if they’re not needed.
Talking openly with doctors and asking questions can help clear up these misunderstandings and stop too many injections from being given.

Bad Effects of Misusing and Overusing Injections:

Using injections in the wrong way, especially for immunization, can lead to serious diseases like Hepatitis B, C, and HIV/AIDS.
Vaccines given through injections can sometimes cause harmful side effects.
Health providers who give injections could also get hurt.
The environment, like soil, air, and water, can also be affected by unsafe injection practices.
Using injections in the wrong way can make immunization programs not work well and affect how many people get protected from diseases.

What to Do if You Get Hurt by a Needle:

If you accidentally get hurt by a sharp needle:

Let the wound bleed, but don’t suck or rub it.
Wash the area well with soap and water.
Cover the wound with a waterproof bandage.
If you know the patient’s name, remember it.
Report to occupational health unit.
Let your boss know and write down what happened.
If patient is thought to be HIV +, post-exposure prophylaxis (PEP) may be required. This should be given as soon as possible after injury.

NB: Staff should be familiar with local pep guidelines!

INJECTION SAFETY AND MANAGEMENT Read More »

FETAL SKULL

The skull bones encase and protect the brain, which is very delicate and subjected to pressure when the fetal head passes down the birth canal.

Fetal skull is to some extent compressible and made mainly of thin pliable tabular (flat) bones forming the vault. This is anchored to the rigid and incompressible bones at the base of the skull.

AREAS OF SKULL: The skull is arbitrarily divided into several zones of obstetrical importance
These are:

Vertex : It is a quadrangular area bounded anteriorly by the bregma and coronal sutures behind by the lambda and lambdoid sutures and laterally by lines passing through the parietal eminences.
Brow : It is an area bounded on one side by the anterior fontanel and coronal sutures and on the other side by the root of the nose and supraorbital ridges of either side.
Face : It is an area bounded on one side by root of the nose and supraorbital ridges and on the other, by the junction of the floor of the mouth with neck.

Fetal skull showing different regions and landmarks of obstetrical significance

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Sinciput is the area lying in front of the anterior fontanel and corresponds to the area of brow and the occiput is limited to the occipital bone.
Flat bones of the vault are united together by non-ossified membranes attached to the margins of the bones. These are called sutures and fontanels. Of the many sutures and fontanels, the following are
of obstetric significance.

Bones of the Vault

The bony structure of the vault originates within a membrane framework. Over time, a process known as ossification hardens these structures from the center outward.

At birth, ossification remains incomplete, resulting in small gaps existing between the bones referred to as sutures and fontanelles. Each bone features a distinct ossification center, which appears as a noticeable protrusion. The full ossification of the skull takes place only in early adulthood.

The vault\’s bony composition encompasses:

The occipital bone, located at the posterior of the head. A portion of this bone contributes to the skull\’s base, encompassing the foramen magnum—a protective passage for the spinal cord as it exits the skull. The occipital protuberance marks the site of ossification.
The two parietal bones situated on either side of the skull. These bones\’ ossification centers are termed parietal eminences.
The two frontal bones, shaping the forehead or sinciput. Ossification initiates at the frontal eminence of each bone. These frontal bones fuse into a singular entity by the age of eight.
The upper segment of the temporal bone on both sides of the head participates in forming the vault\’s structure.

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Regions and landmarks of the fetal skull

The fetal skull\’s various segments are defined by distinct regions, each marked by significant landmarks(see figure above). These points of reference hold particular importance for midwives during vaginal examinations, aiding in determining the fetal head\’s position.

• The occiput region occupies the space between the foramen magnum and the posterior fontanelle. The area below the occipital protuberance (landmark) is referred to as the sub-occipital region.

• The vertex region is enclosed by the posterior fontanelle, the paired parietal eminences, and the anterior fontanelle.

• The forehead, or sinciput region, spans from the anterior fontanelle and the coronal suture to the orbital ridges.

• Extending from the orbital ridges and the base of the nose to the junction of the chin, or mentum (landmark), and the neck is the face region. The point situated between the eyebrows is recognized as the glabella

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SUTURES

The sagittal or longitudinal suture is situated between two parietal bones.
The coronal sutures run between the parietal and frontal bones on both sides.
The frontal suture is positioned between two frontal bones.
The lambdoid sutures separate the occipital bone and the two parietal bones.

Importance:

It allows smooth movement of one bone over the other during head molding, which is significant as the head passes through the pelvis during labor.
Palpating the sagittal suture during internal examination in labor provides insight into head engagement (asynclitism or synclitism), the degree of internal head rotation, and head molding.

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FONTANELS

A wide gap in the suture line is referred to as a fontanel. Among the numerous fontanels (total of 6), two hold obstetric significance: (1) Anterior fontanel or bregma and (2) Posterior fontanel or lambda.

Anterior fontanel: It results from the fusion of four sutures in the midline. The sutures include the frontal suture anteriorly, the sagittal suture posteriorly, and the coronal sutures on either side. Its shape resembles a diamond, with anteroposterior and transverse diameters of approximately 3 cm each. The floor consists of a membrane, which undergoes ossification around 18 months after birth. If ossification does not occur even after 24 months, it becomes pathological.

Importance:

Palpating it during internal examination indicates the degree of head flexion.
It aids in head molding.
Due to its membranous nature persisting after birth, it accommodates significant brain growth, with the brain nearly doubling in size during the first year of life.
Palpation of the floor reflects intracranial conditions – depressed in dehydration, elevated in raised intracranial pressure.
In rare cases, blood collection and exchange transfusion can be performed through it, via the superior longitudinal sinus.
Although uncommon, cerebrospinal fluid can be drawn through the angle of the anterior fontanel from the lateral ventricle.

Posterior fontanel: It is formed by junction of three suture lines — sagittal suture anteriorly and lambdoid suture on either side. It is triangular in shape and measures about 1.2 × 1.2 cm (1/2\” × 1/2\”).
Its floor is membranous but becomes bony at term. Thus, truly its nomenclature as fontanel is misnomer.
It denotes the position of the head in relation to maternal pelvis.
Sagittal fontanel: It is inconsistent in its presence. When present, it is situated on the sagittal suture at the junction of anterior two-third and posterior one-third. It has got no clinical importance.

DIAMETERS OF SKULL

The engaging diameter of the fetal skull depends on the degree of
flexion present. The anteroposterior diameters of the head which may engage are:

Presentation	Diameter	(cm)	Attitude of the Head
Vertex	Suboccipitobregmatic — extends from the nape of the neck to the center of the bregma	9.5	Complete flexion
Vertex	Suboccipito-frontal — extends from the nape of the neck to the anterior end of the anterior fontanel or center of the sinciput	10	Incomplete flexion
Vertex	Occupitofrontal — extends from the occipital eminence to the root of the nose (Glabella)	11.5	Marked deflexion
Brow	Mento-vertical — extends from the midpoint of the chin to the highest point on the sagittal suture	14	Partial extension
Face	Submentovertical — extends from junction of floor of the mouth and neck to the highest point on the sagittal suture	11.5	Incomplete extension
Face	Submentobregmatic — extends from junction of floor of the mouth and neck to the center of the bregma	9.5	Complete extension

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Transverse diameters

The transverse diameters of the fetal skull;

There are also two transverse diameters,
• The biparietal diameter (9.5 cm) – the diameter between the two parietal eminences.
• The bitemporal diameter (8.2 cm) – the diameter between the two furthest points of the coronal suture at the temples.
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Knowledge of the diameters of the trunk is also important for the birth of the shoulders and breech

Bisacromial diameter 12 cm: This is the distance between the acromion processes on the two shoulder blades and is the dimension that needs to pass through the maternal pelvis for the shoulders to be born. The articulation of the clavicles on the sternum allows forward movement of the shoulders, which may reduce the diameter slightly.
Bitrochanteric diameter 10 cm: This is measured between the greater trochanters of the femurs and is the presenting diameter in breech presentation.

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Presenting diameters

Some presenting diameters are more favourable than others for easy passage through the maternal pelvis and this will depend on the attitude of the fetal head.

This term attitude is used to describe the degree of flexion or extension of the fetal head on the neck. The attitude of the head determines which diameters will present in labour and therefore influences the outcome.
The presenting diameters of the head are those that are at right-angles to the curve of Carus of the maternal pelvis.
There are always two: a longitudinal diameter and a transverse diameter. The presenting diameters determine the presentation of the fetal head, for which there are three:

Vertex Presentation: When the head displays pronounced flexion, the sub-occipitobregmatic diameter (9.5 cm) and the biparietal diameter (9.5 cm) come into play. Given their equal length, the presenting area takes on a circular form, optimally conducive to cervix dilation and successful head birth. The sub-occipitofrontal diameter (10 cm) is the dimension that expands the vaginal orifice. Conversely, when the head is deflexed, the presenting diameters shift to the occipitofrontal (11.5 cm) and the biparietal (9.5 cm). This circumstance often arises when the occiput occupies a posterior position. In such cases, if the posterior position persists, the diameter expanding the vaginal orifice will be the occipitofrontal (11.5 cm).
Face Presentation: Complete extension of the head leads to the submentobregmatic diameter (9.5 cm) and the bitemporal diameter (8.2 cm) serving as the presenting dimensions. The sub-mentovertical diameter (11.5 cm) is the dimension that stretches the vaginal orifice.
Brow Presentation: Partial extension of the head results in the mentovertical diameter (13.5 cm) and the bitemporal diameter (8.2 cm) becoming the presenting diameters. In instances where this presentation persists, vaginal birth becomes less likely.

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Moulding

The term moulding is used to describe the change in shape of the fetal head that takes place during its passage through the birth canal.

Alteration in shape is possible because the bones of the vault allow a slight degree of bending and the skull bones are able to override at the sutures. This overriding allows a considerable reduction in the size of the presenting diameters, while the diameter at right-angles to them is able to lengthen owing to the give of the skull bones(Fig. 7.13).

The shortening of the fetal head diameters may be by as much as 1.25 cm. The dotted lines in Figs 7.14–7.19 illustrate moulding in the various presentations.
Additionally, moulding is a protective mechanism and prevents the fetal brain from being compressed as long as it is not excessive, too rapid or in an unfavourable direction. The skull of the pre-term infant is softer and
has wider sutures than that of the term baby, and hence may mould excessively should labour occur prior to term.

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