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Community dialogue

Community dialogue

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.

community

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

CHALLENGES OF CARRYING COMMUNITY DIALOGUE

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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 community

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)

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.
  1. NO POVERTY
  2. ZERO HUNGER
  3. GOOD HEALTH AND WELL-BEING
  4. QUALITY EDUCATION
  5. GENDER EQUALITY
  6. CLEAN WATER AND SANITATION
  7. AFFORDABLE AND CLEAN ENERGY
  8. DECENT WORK AND ECONOMIC GROWTH
  9. INDUSTRY, INNOVATION AND INFRASTRUCTURE
  10. REDUCED INEQUALITIES
  11. SUSTAINABLE CITIES AND COMMUNITIES
  12. RESPONSIBLE CONSUMPTION AND PRODUCTION
  13. CLIMATE ACTION
  14. LIFE BELOW WATER
  15. LIFE ON LAND
  16. PEACE, JUSTICE AND STRONG INSTITUTIONS
  17. 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:

  1. No Poverty 💰: End poverty in all its forms everywhere.
  2. Zero Hunger 🍲: End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.
  3. Good Health and Well-being 🏥: Ensure healthy lives and promote well-being for all at all ages.
  4. Quality Education 📚: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.
  5. Gender Equality ♀️: Achieve gender equality and empower all women and girls.
  6. Clean Water and Sanitation 💧: Ensure availability and sustainable management of water and sanitation for all.
  7. Affordable and Clean Energy 💡: Ensure access to affordable, reliable, sustainable, and modern energy for all.
  8. Decent Work and Economic Growth 💼: Promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all.
  9. Industry, Innovation, and Infrastructure 🏗️: Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation.
  10. Reduced Inequalities ↔️: Reduce inequality within and among countries.
  11. Sustainable Cities and Communities 🏙️: Make cities and human settlements inclusive, safe, resilient, and sustainable.
  12. Responsible Consumption and Production ♻️: Ensure sustainable consumption and production patterns.
  13. Climate Action 🌎: Take urgent action to combat climate change and its impacts.
  14. Life Below Water 🌊: Conserve and sustainably use the oceans, seas, and marine resources for sustainable development.
  15. 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.
  16. 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.
  17. 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.

  1. Poor (Poverty)
  2. No Food (Zero Hunger)
  3. Sick (Good Health)
  4. School (Quality Education)
  5. Girls (Gender Equality)
  6. Clean Water (Clean Water and Sanitation)
  7. Electricity (Affordable and Clean Energy)
  8. Decent Jobs (Decent Work)
  9. Factory (Industry, Innovation, and Infrastructure)
  10. Reduce Inequality
  11. Sustainable City (Sustainable Cities)
  12. Responsible Consumption
  13. Climate
  14. Ocean (Life Below Water)
  15. Forest (Life on Land)
  16. Good Institutions (Peace, Justice, and Strong Institutions)
  17. 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.

  1. People (Poverty)
  2. Have (Hunger)
  3. Healthy (Health)
  4. Educated (Education)
  5. Girls (Gender)
  6. Who (Water)
  7. Earn (Energy)
  8. Decent (Decent Work)
  9. Income (Industry)
  10. Reducing (Reduced Inequality)
  11. Sustainable (Sustainable Cities)
  12. Conserving (Consumption)
  13. Climate (Climate Action)
  14. Oceans (Oceans)
  15. Land (Life on Land)
  16. Peaceful (Peace)
  17. Partnerships (Partnerships)

sustainable

Goal 1: No Poverty

  • Objective: To eliminate poverty in all its forms globally.

Targets:

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

sustainable

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.

sustainable

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.

sustainable

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.

sustainable

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.

sustainable

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.

sustainable

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.

sustainable

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.

sustainable

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.

sustainable

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.

sustainable

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.

sustainable

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.

sustainable

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.”

sustainable

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.

sustainable

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.

sustainable

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 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

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:

  1. The person getting the injection should be safe.
  2. The health worker giving the injection should be safe.
  3. 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:

  1. Always use a new syringe and needle for each vaccine.
  2. Keep injection equipment and vaccine clean to avoid contamination.
  3. Prepare injections in a clean area where there’s little chance of contamination from blood or body fluids.
  4. Use a clean, sterile needle to puncture the top of multi-dose vials.
  5. Don’t leave the needle in the stopper of the vial.
  6. Protect your fingers with a small gauze pad when opening ampoules.
  7. Throw away a needle that touches anything not sterile, like your hands or surfaces.
  8. Be ready for any sudden movements from the patient during and after the injection.
  9. To avoid getting hurt, don’t put the cap back on a used needle; put it straight into a safety box.
  10. 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.
  11. Close and seal the safety boxes before taking them to a safe place. Don’t open, empty, or reuse them.
  12. Handle and dispose of injection waste in a way that’s safe for the environment.
  13. Prevent accidents for the people in charge of throwing away the waste.
  14. Don’t put empty vials in the safety box; they might burst when burned.
  15. 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:

  1. Follow the right infection control practices and keep everything clean when preparing and giving injections.
  2. Don’t use the same syringe for different patients, even if you change the needle or inject through a tube.
  3. Never put a used needle or syringe into a vial.
  4. Don’t use medications meant for one use on more than one patient.
  5. Don’t use a bag of IV solution for more than one patient.
  6. Use multi-dose vials for one patient if possible.
  7. 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.
  8. Wear a facemask when injecting material or placing a catheter into the epidural or subdural space.

Ways to Prevent Unsafe Injections:

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

Prevent Needle Pricks

  1. 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.

  2. Follow Proper Handling: Handle needles with care and avoid recapping after use. Dispose of them immediately in designated sharps containers.

  3. 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.

  4. Safe Disposal: Properly dispose of used needles and sharps in puncture-resistant containers. Ensure containers are close to where procedures are performed.

  5. Use Needleless Systems: Employ needleless systems whenever possible for medication preparation and administration, reducing the need for needles.

  6. Adopt Engineering Controls: Install safety-engineered devices and equipment that minimize the risk of needle pricks during procedures.

  7. Education and Training: Provide thorough training on proper needle handling, disposal, and safety protocols to all healthcare workers.

  8. Sharps Injury Prevention Program: Establish a program that identifies risks, offers guidance, and encourages reporting of any needle prick incidents.

  9. 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.

  10. Sharps Containers Accessibility: Place sharps containers at convenient locations throughout the facility to encourage proper disposal.

  11. Post-Procedure Safety: After using needles, avoid hurriedly disposing of equipment. Take time to ensure proper disposal and safety measures.

  12. Communication and Collaboration: Encourage open communication among healthcare team members about needle safety and potential risks.

  13. Needleless Catheters: Use needleless catheter systems for intravenous access to minimize needle use and related risks.

  14. Safety Syringes: Implement safety syringes with features that reduce the risk of needle pricks during injection or withdrawal.

  15. 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:

  1. Stay Calm: Take a deep breath and try to stay calm. Accidents can happen, but you can take steps to minimize any potential harm.

  2. 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.

  3. Wash the Area: Clean the affected area with soap and running water. Thoroughly wash the wound for at least 20 seconds.

  4. 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.

  5. 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.

  6. 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.

  7. Collect Information: Note down important details, such as the type of exposure, the circumstances, and any information about the source patient.

  8. 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.

  9. 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.

  10. 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.

injection Disposal criteria in mass immunization flowchart

Disposal criteria in mass immunization

MethodsStrengthsWeaknesses
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:

  1. People might think injections are stronger and faster, so they prefer them.
  2. Some believe that doctors think injections are the best treatment.
  3. Doctors might give more injections because they want to make patients happy.
  4. Also, doctors can charge more money for injections, so they might prescribe them even if they’re not needed.
  5. 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:

  1. Using injections in the wrong way, especially for immunization, can lead to serious diseases like Hepatitis B, C, and HIV/AIDS.
  2. Vaccines given through injections can sometimes cause harmful side effects.
  3. Health providers who give injections could also get hurt.
  4. The environment, like soil, air, and water, can also be affected by unsafe injection practices.
  5. 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:

  1. Let the wound bleed, but don’t suck or rub it.
  2. Wash the area well with soap and water.
  3. Cover the wound with a waterproof bandage.
  4. If you know the patient’s name, remember it.
  5. Report to occupational health unit.
  6. Let your boss know and write down what happened.
  7. 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

FETAL SKULL

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:

  1.  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.
  2.  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.

\"fetal\"

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.
\"fetal\"

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:

  1. 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).

  2. 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.

  3. 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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FETAL SKULL Read More »

research

Terms Used in Research

COMMON TERMS USED IN RESEARCH

  • Abstract: A concise summary of a study that communicates the
    essential information about the study.
  • Assumption: A statement based on logic or reason whose correctness
    or validity is taken for granted.
  • Data: Units of information.
  • Descriptive research: Non experimental research designed to discover new meanings and to provide new knowledge when there is little known about the phenomena of interest.
  • Hypothesis: A statement of predicted relationship between two or
    more variables in a research study. An educated or calculated guess by the researcher.
  • Informed consent: Voluntary agreement by a study subject to
    participate in the research study after being fully informed about the study.
  • Phenomena: Facts or events that can be observed or scientifically
    described because they are known through senses rather than
    thoughts or intuition.
  • Reliability: Stability of a measuring item overtime. A measure of the extent to which random variation may have influenced the stability and consistency of results.
  • Validity: Ability of the test item to measure what it is expected to measure. Extent to which research findings represent reality.
  • Variable: An attribute or characteristic that can have more than one value, such as height, weight and blood pressure.
  • Dependent variable: The variable that changes as the independent variable is manipulated by the researcher.
  • Independent variable: The variable that is purposely manipulated or changed by the researcher.
  • Confounding variable: Variable outside the purpose of the study that could influence the study’s results.
  • Qualitative data: Data characterized by words rather than numbers
  • Quantitative data: Data characterised by numbers
  • Population: A total group of individual people or things meeting the designed criteria of interest to the researcher.
  • Sample: A smaller part of the population selected to represent the
    whole population.

More Terminologies in simple detail

ABSTRACT

A clear, concise summary that communicates the essential information about the study. In research journals, it is usually located at the beginning of an article. It serves two main purposes:

  1.  To help potential readers determine the relevance of your paper for their own research.
  2.  To communicate your key findings to those who don’t have time to read the whole paper.
research data
DATA

Units of information or any statistics, facts, figures, general material, evidence, or knowledge collected during the course of the study. Also referred to as the processed information. The data is classified into majorly four categories/scales:

  1. • Nominal data.
  2. • Ordinal data.
  3. • Discrete data.
  4. • Continuous data.
Classifications/Scales of Data – Further Classified
Classifications/scales of data-further classified research
VARIABLES

Attributes or characteristics that can have more than one value, such as height or weight. Variables are qualities or quantities, properties or characteristics of people, things, or situations that change or vary.

INDEPENDENT VARIABLE

Variables that are purposely manipulated or changed by the researcher. It is also called as “MANIPULATIVE VARIABLE.” For example, if we have a topic stated as “factors influencing the uptake of family planning services,” then “factors influencing” are our independent variables.

Dependent Variable

The variable that is influenced by the independent variable. It is also called the outcome variable. The dependent variable is the variable the researcher is interested in understanding, explaining, or predicting. For example, “uptake of family planning services” is the dependent variable.

OPERATIONAL DEFINITION

Refers to the way in which the researcher defines the variables under investigation. Operational definitions are stated in such a way by the investigator specifying how the study variables will be measured in the actual research situation.

HYPOTHESIS

A statement of the predicted relationship between two or more variables in a research study; an educated or calculated guess by the researcher.

LIMITATIONS

Restrictions in a study that may decrease the credibility and generalizability of the research findings. The limitations of a study are its flaws or shortcomings, which could be the result of unavailability of resources, small sample size, unsound methodology, etc. Listing the limitations of your study reflects honesty and transparency and shows that you have a complete understanding of the topic.

POPULATION

The entire set of individuals or objects having some common characteristics selected for a research study is referred to as the population.

TARGET POPULATION

The entire population in which the researchers are interested and to which they would like to generalize the research findings.

ACCESSIBLE POPULATION

The group of people or objects that is available to the researcher for a particular study.

SAMPLE

A part or subset of the population selected to participate in the research study.

REPRESENTATIVE SAMPLE

A sample whose characteristics are highly similar to that of the population from which it is drawn.

SAMPLING

The act, process, or technique of selecting a representative part of a population for the purpose of determining parameters or characteristics of the whole population. The process of selecting a sample from the target population to represent the entire population.

PROBABILITY SAMPLING

The selection of subjects or sampling units from a population using a random procedure. Examples include Simple Random Sampling and Stratified Random Sampling.

NON-PROBABILITY SAMPLING

The selection of subjects or sampling units from a population using a non-random procedure. Examples include Convenient Sampling and Purposive Sampling.

RELIABILITY

The degree of consistency or accuracy with which an instrument measures the attributes it is designed to measure.

VALIDITY

The degree to which an instrument achieves what it is intended to measure.

Pre-testing

Pretesting is the stage in research when tools/data collection instruments like the questionnaires are tested on members of the target population. Pre-testing is the administration of the data collection instrument with a small set of respondents from the population for the full-scale research. If problems occur in the pre-test, it is likely that similar problems will arise in full-scale administration.

Purpose of Pretesting
  • The purpose of pre-testing is to identify problems with the data collection instrument and find possible solutions.
  • Pretesting ensures the data collections tools are valid hence generation of reliable results
  • Pre-testing also helps assess whether respondents are able and willing to provide the needed information
  • Pre-testing allows the responsible assessor to test solutions to problems with the questionnaire.
Principles of Pretesting
  • Pre-testing should be conducted in circumstances that are as similar as possible to actual data collection
  • Pre-testing should be conducted on population members as similar as possible to those that will be sampled.
  • Careful notes should be taken on the problems encountered and possible solutions should be identified.
PILOT STUDY

A pilot study is a smaller version of a proposed study conducted to refine the methodology. It is developed much like the proposed study, using similar subjects, the same settings, the same treatment, the same data collection, and analysis techniques. A study carried out at the end of the planning phase of research to explore and test the research elements to make relevant modifications in research tools and methodology. It is aimed at testing the data instruments to ascertain its feasibility in the actual conduct of the research.

ANALYSIS

Method of organizing, sorting, and scrutinizing data in such a way that research questions can be answered or meaningful inferences can be drawn. A well-done research analysis is preceded by the presentation and interpretation of the research findings.

INFORMED CONSENT

The process of learning the key facts about a clinical trial before deciding whether or not to participate. It is also a continuing process throughout the study to provide information for participants. To help someone decide whether or not to participate, the doctors, nurses, or research participants involved in the trial explain the details of the study.

COHORT

In epidemiology, a group of individuals with some characteristics in common. Cohorts can be prospective or retrospective. Prospective cohort means you study participants from the present to the future. Retrospective cohort means you study participants based on their past.

BIAS

When a point of view prevents impartial judgment on issues relating to the subject of that point of view. In clinical studies, bias is controlled by blinding and randomization.

BLIND

A randomized trial is “Blind” if the participant is not told which arm of the trial he is on. A clinical trial is “Blind” if participants are unaware of whether they are in the experimental or control arm of the study; also called masked.

SIDE EFFECTS

Any undesired actions or effects of a drug or treatment. Negative or adverse effects may include headache, nausea, hair loss, skin irritation, or other physical problems. Experimental drugs must be evaluated for both immediate and long-term side effects.

Terms Used in Research Read More »

Concepts of Primary Health Care phc and cbhc

PRIMARY HEALTH CARE (PHC)

PRIMARY HEALTH CARE (PHC)

PRIMARY HEALTH CARE (PHC) INTRODUCTION

BACK GROUND AND FACTS ON PHC

In 1978 world leaders, international organizations and health authorities (WHO & UNICEF gathered in Alma-Ata (Almaty), Kazakhstan, and released the Declaration of Alma-Ata on Primary Health Care, which remains a landmark document in the history of global health. This was to get way forward to the health problems faced by people of the whole world.

The Alma-Ata Declaration established a standard of public commitment to making community-driven, quality health care accessible, both physically and financially, for all.
 
134 governments ratified the WHO Declaration of Alma-Ata, asserting that:
    (a) Health for all could be achieved by 2000.
    (b) Governments have a responsibility for the health of their people that can be fulfilled only by
the provision of adequate health and social measures.
    (c) Primary health care is the key to attaining a level of health that will permit their citizens to lead a socially and economically productive life.
 
The Alma-Ata Declaration of 1978 emerged as a major milestone of the 20th century in the field of public health and it identified Primary Health Care (PHC) as the key to the attainment of the goal of Health for All (HFA).

HFA is defined as “the attainment by all peoples of the world by a particular date (kept at that time as the year 2000), of a level of health that will permit them to lead a socially and economically productive life”.

The Global Strategy for Health for All by the Year 2000 (HFA2000) set the following guiding targets to be achieved by year 2000:

  •  Life expectancy at birth above 60 years
  • Infant mortality rate below 50 per 1000 live births
  • Under-5 mortality rate below 70 per 1000 live births.
  • About 930 million people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of there household budget.
  • Scaling up primary health care (PHC) interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.
  • Achieving the targets for PHC requires an additional investment of around US $ 200 to US$ 370 billion a year for a more comprehensive package of health services.
  • At the UN high level UHC meeting in 2019, countries committed to strengthening primary health care.
  • WHO recommends that every country allocate or reallocate an additional 1% of GDP to PHC from government and external funding sources.

What is primary health care?

  • The concept of PHC has been repeatedly reinterpreted and redefined in the years since 1978, leading to confusion about the term and its practice..
  • A clear and simple definition has been developed to facilitate the coordination of future PHC efforts at the global, national, and local levels and to guide their implementation:

PHC is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment. “WHO and UNICEF”

✔A Vision for primary health care in the 21st century: Towards UHC (Universal Health coverage) and the sustainable development goals(SDGs).

  • UHC Means that all individuals && communities receive the health services they need without suffering financial hardships.

 PHC entails three inter-related and synergistic components, including:

  • Comprehensive integrated health services that embrace primary care as well as public health goods and functions as central pieces
  • Multi-sectoral policies and actions to address the upstream and wider determinants of health:
  • Engaging and empowering individuals. families, and communities for increased social participation and enhanced self-care and self-reliance in health.
  1. For universal health coverage (UHC) to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people, with people.
  2. PHC is rooted in a commitment to social justice, equity, solidarity and participation.
  3. PHC requires governments at all levels to underscore the importance of action beyond the health sector in order to pursue a whole-of government approach to health, including health-in-all-policies, a strong focus on equity and that encompass the entire life-course.
  4. PHC addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing.
  5. It provides whole-person care for health needs throughout the lifespan, not just for a set of specific diseases.
  6. Primary health care ensures people receive quality comprehensive care – ranging from promotion and prevention to treatment, rehabilitation and palliative care as close as feasible to people’s everyday environment
  7. In May 1998, the World Health Organization adopted a resolution in support of the new global Health for All policy.
  8. The new policy, Health for All in the 21st Century, succeeds the Health for All by the Year 2000 strategy launched in 1977
  9. In the new policy, the worldwide call for social justice is elaborated in key values, goals, objectives and targets.
• The l0 global health targets are the most concrete end points to be pursued.
 They can be divided into three subgroups, Health outcome targets (total four targets). targets on determinants of health (two) and targets on health policies and sustainable health systems (four targets).

Global Health Targets

Health Outcome
  1.  Health equity: Childhood stunting-By 2005, health equity indices will be used within and between countries as a basis for promoting and monitoring equity in health. Initially equity will be assessed on the basis of a measure of child growth.
  2. Survival: Maternal mortality rates, child mortality rates, life expectancy-By 2020, the targets agreed at world conferences for maternal mortality rates (<100/100,000 live births). under 5 years or child mortality rates (<45/1000 live births) and life expectancy (>70 years) will be met.
  3. Reverse global trends of five major pandemics: By 2020, the worldwide burden of disease will be reduced substantially. This will be achieved by implementing sound disease control programs aimed at reversing the current trends of increasing incidence and disability caused by tuberculosis, HIV/AIDS, malaria, diseases related to tobacco and violence or trauma.
  4.  Eradicate and eliminate certain diseases: 
  • Measles will be eradicated by 2020. Lymphatic filariasis will be eliminated by the year 2020.
  •  The transmission of Chagas’ discase will be interrupted by 2010. 
  • Leprosy will be eliminated by 2010 and trachoma will be eliminated by 2020. In addition, vitamin A and iodine deficiencies will be eliminated before 2020.
Determinants of Health
       5. Improve access to water, sanitation, food and shelter: By 2020, all countries, through intersectoral action, will have made major progress in making available safe drinking water, adequate sanitation and food and shelter in sufficient quantity and quality and in managing risks to health from major environmental determinants, including chemical, biological

and physical agents.

       6. Measures to promote health: By 2020, all countries will have introduced and be actively managing and monitoring, strategies
those strengthen health enhancing lifestyles and weaken health damaging ones through a combination of regulatory, economic, educational, organizational and community based programs
 
Health Policies and Sustainable Health Systems
       7. Develop, implement and monitor national Health for All policies: By 2005, all member states will have operational mechanisms for developing, implementing and monitoring policies that are consistent with this Health for All policy.
       8. Improve access to comprehensive essential health care: By 2010, all people will have access throughout their lives to comprehensive, essential, quality health care, supported by essential public health functions.
 
       9. Implement global and national health information and surveillance systems: By 2010, appropriate global and national health information, surveillance and alert systems will be established.
 

       10. Support research for health:

  • By 2010, research policies and institutional mechanisms will be operational at global, regional and country levels.
  • The Member States of WHO have to translate the Regional Health Policy into realistic national policies backed up by appropriate implementation plans.
  • WHO, on its part, will provide support to the Member States based on countries’ realities and needs, especially community health problems, the strengthening of health systems and services and the mobilization of countries and the international community for concerted action in the harmonization of national policies with regional and global policies.

Why is primary health care important?

  • Member States have committed to primary health care renewal and implementation as the cornerstone of a sustainable health system for UHC, health related Sustainable Development Goals (SDGs) and health security.
  • PHC provides the ‘programmatic engine’ for UHC, the health-related SDGs and health security.
  • This commitment has been codified and reiterated in the Declaration of Astana, the accompanying World Health Assembly Resolution, the 2019 Global Monitoring Report on UHC, and the United Nations General Assembly high-level meeting on UHC.
  • UHC, the health-related SDGs and health security goals are ambitious but achievable.
  • Progress must be urgently accelerated, and P1C provides the means to do so.
  • PHC is the most inclusive, equitable, cost-effective and efficient approach to enhance people’s physical and mental health, as well as social well-being.
  • Evidence of wide-ranging impact of investment in PHC continues to grow around the world, particularly in times of crisis such as the COVID-19 pandemic.
  • Across the world, investments in PHC improve equity and access, health care performance, accountability of health systems, and health outcomes.
  • While some of these factors are directly related to the health system and access to health services,
  • The evidence is clear that a broad range of factors beyond health services play a critical role in shaping health and well-being.
  • These include social protection, food systems, education, and environmental factors, among others.
  • PHC is also critical to make health systems more resilient to situations of crisis, more proactive in detecting early signs of epidemics and more prepared to act early in response to surges in demand for services.

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Teaching and Learning process

TEACHING-LEARNING PROCESS

Teaching – Learning Process

Teaching – Learning Process Learning Outcomes.

By the end of this session, learning will be able to;
1. Define teaching and learning
2. State elements that make up a teaching -learning process
3. List the phases involved in teaching process
4. Outline the tasks of the teacher
5. State the phases of learning
6. Explain factors influencing learning
7. Mention ways how teachers can use to help students learn
Definitions
  • Education – is a process through which an individual attains knowledge, skills, attitudes and other abilities required for leading a productive life in the society
  • Teaching: deliberate intervention that involves planning and implementation of instructional activities in order to bring about desired behavioral changes in students.
  • Learning – is the process of acquiring new knowledge skills and attitudes which enable students to do something that they could not do before OR this is a change in an individual’s behavior as a result of receiving instructions.
 

Teaching-learning process

This a combined process where an educator assesses learning needs, establishes specific learning objectives, develops teaching and learning strategies, implements plan of work and evaluates the outcome of the instruction.
  • Learning is brought about through teaching. Teaching process is the arrangement of the environment within which the students can interact and study how to learn.
The process of teaching and learning aims at transmission of knowledge, imparting skills and formation of attitude, values and behavior.

Elements/components of teaching-learning process

  1. Learner– someone who is going to attain knowledge and skills in order to change behavior
  2.  Teacher– someone who selects and organizes teaching-learning process
  3. Learning objectives– intended learning outcomes which can be observed or measured.
  4. Sequence of stimulus-response stimulation (teaching) -here the teacher starts to direct learning in order to ensure enhancement of student’s cognitive (knowledge), psychomotor (skills) and affective (attitude ) abilities.
  5. Reinforcement of the behavior-there should be an activity which increases the likelihood that some event will occur again. It can involve continuous practice of what has been taught.
  6.  Monitoring, assessment and evaluation-it involves finding out whether the set objectives were achieved.

TEACHING PROCESS 

Qualities of a good teacher
  •  Enthusiastic with content to be taught.
  • Organized
  • Good communicator
  • Active listener
  • Empathy
  • Time manager
  • Confident
  • Respectful
  • Counsellor
  • Honesty/ trustworthy
  • Knowledgeable
  • Good teaching ethics
  • Good leader- lead and guide learners
  • Team work
  • Creative /innovative

The Teaching and Learning Process refers to phases of teaching i.e. steps  taken to achieve effective teaching and learning. Sometimes it is referred to  as The Instruction Process. 

They include: 

  1. Planning for teaching: 
  •  Mind about the nature or level of the learners- whom am I going  to teach? 
  •  Prepare teaching objectives-what am I going to teach? ∙ Prepare the teaching method(s)-what appropriate strategy or  strategies am I going to use in teaching? 
  •  Prepare the teacher’s and learners’ tasks-what will I do to involve  my learners in their learning? 
  •  Prepare teaching aids/materials-what do I need to teach/what  tools or equipment will I use in teaching? 
  •  Prepare the assessment and evaluation methods-how will I know  that my learners have achieved the level of ability or competence  I want? 
  •  Research and review the content meant for teaching-am I  confident of what I am going to teach? 

Remember: failing to prepare for teaching you are preparing to fail  teaching

        2. Implementation of teaching (active phase): 

  •  Creating rapport 
  •  Introducing teaching/learning objectives 
  •  Assessing learners’ prior knowledge 
  •  Giving content and major ideas of the session, 
  •  Implementing the teaching methods.  
  1. Assessment and Evaluation of teaching:  

Measure the level of acquired skills, attitudes or knowledge (determine the  level of achievement of the objectives of teaching and learning) by: 

  • ∙ Ask one of the learners to summarize  
  • ∙ Ask important questions about what has been taught 
  • ∙ Administer the assessment tool/test 
  • ∙ Score/mark the learners 
  • ∙ Giving feedback about performance of the learners 
  • ∙ Determine or decide the direction to take basing on their  performance

THE SIX MAJOR TASKS OF A TEACHER

  1.  Planning
  • Decide what students should learn (prepare objectives / tasks)
  • Put the contents in a suitable sequence
  • Allocate amount of time and different learning activities.
  • Select learning activities and teaching methods
  • Choose assessment procedures
  • Identify resources needed
  • Inform the student about the plan
 
        2. Communications

  • Tell, explain, advise
  • Help students to exchange ideas. Students can still learn in your absence
  • Provide students’ thinking
  • Use varied teaching techniques, Be creative
  • Detect whether students understand.
 
         3. Providing Resources

  • Prepare, select or adapt educational materials e.g. handouts, exercises, reference books etc.
  • Arrange learning experiences, especially opportunities to practice skills (visit the wards, Field visit, attachments to clinical areas & projects etc.)
  • Arrange aceess to materials (Such as patients, learning models, libraries, audio visual programs etc)
        4. Counselling

  • Show students that you care.
  • Listen and attempt to understand
  • Help students to identify their options and to make their decisions
  • Provide advice and information that helps students.
 
     5. Assessment

  • Design an assessment that measures how much students have learnt
  • Use the assessment to guide students learning
  • Use the assessment to give feedback that modifies teaching.
  • Use the assessment to decide whether students are competent to provide health care.
  • Encourage students to use self -assessment and peer-assessment.   
     6. Continuous self education

  • Know the subject matter that is taught and where to find relevant information
  • Know the way in which health care is provided locally.
  • Set an example as a continuous learner.
LEARNING PROCESS

LEARNING PROCESS

Learning is defined as a change in an individual’s behaviour caused by experiences or self activity
 

Types of learning

Learning involves either physical or mental activities. There are different types of learning which could be classified as:

  1. Depending on the way of acquiring knowledge
  •  Formal learning– it occurs in organized or structured form like school or workplace
  • Informal learning-this is learning that occurs away from structured, formal environment. It happens through self-directed learning or experience like observing,
  • Non-formal learning– it includes various structured learning situation which do not have a curriculum or syllabus e.g swimming, driving, scouting sessions
        2. Depending on the number of individuals
 
  • Individual learning- involves self directed training and instructions
  • Group learning– co-operative learning involving groups of people

Roles of a learner

 
  1. Attending classes on time
  2. Completing all assignments
  3. Active participation in class and all school activities
  4. Revision or reading on regular basis
  5. Respecting teachers and colleagues
  6. Plan their time
  7. Give feedback to teachers
  8. Maintain discipline in the class
  9. Maintain environment clean and keep school property in good condition
  10. Abide to school rules and regulation
 

Phases of Learning

These are steps involved as learning is taking place.
  1.  Motivation phase– the learner must be motivated to learn by expectation that learning will be rewarding. Each learner has their motives and needs in life to achieve.
  2. Apprehending phase– learner stands or pay attention if learning has to take place. It involves understanding or perceiving what is taught.
  3. Acquisition phase – while learner is paying attention, there is attainment of new information or behaviour.
  4. Retention phase– newly acquired information must be transferred from short term to long term memory.
  5. Recall phase – recall previously learned information; to learn to gain access to what has been learned is a critical phase in learning.
  6. Generalization phase – transfer of information to new situations allows application of the learned information in the context in which it was learned.
  7.  Feedback phase – students must receive feedback on their performance after assessment.

WAYS TEACHERS CAN USE TO HELP STUDENT LEARN (ROLES)

  1. Individualize: Allow for individual differences and abilities.
  • Accept all students as they are, and then start to do a good work in them.
  • Consider students as individuals, engaged each in learning on their own.
  • Vary your teaching.
  • Try to make sure that each student gets what he / she needs.
 
   2. Active learning: Give students some activity to do, e.g. ask questions, set problems, projects, or case studies, etc

  • Students learn by doing these activities.
   3.  Give feedback; Give frequent, early, positive feedback that supports students’ beliefs that they can do well.

  •  Tell students how well they are doing things,
  • What was done poorly and how they could have done better in order to correct their mistakes.

   4. Also encourage students to provide their own feedback

  • Like, how best they need to learn, check their own work for mistakes etc.
   5. Clarity: Make your teaching clear, speak loudly, write neatly, use visual aids and make your teaching meaningful and relevant to the students.
  •   Help students to make sense of what they are learning by showing how it is relevant to them
   6. Ensure mastery: Check that all students know and can do it.
  • Provide plenty of practice and repetition of what they learn
  7. Tell students what they need to do to succeed in your course.
  • Don’t let your students struggle to figure out what is expected of them.
  • Reassure students that they can do well in your course, and tell them exactly what they must do to succeed
   8. Be enthusiastic (love) about your subject.
  • An instructor’s enthusiasım is a crucial factor in student motivation. If you become bored or apathetic, students will too.
   9. Sequence: Organise what is to be learned so that students find it easy and systematic.
  • From easy to difficult
  • From what they know to what they don’t know
  10. Demonstrations: Help students see very clearly what they are trying to learn.
  • – Use illustrations
  11. Vary your teaching methods.
  • Variety reawakens students’ involvement in the course and their motivation.
  • Break the routine by incorporating a variety of teaching activities and methods in your course: ward teaching, role playing, debates, brainstorming, discussion, demonstrations, case studies, audiovisual presentations, or small group work.
12. Design tests that encourage the kind of learning you want students to achieve
 
  • If you base your tests on memorizing details, students will focus on memorizing facts.
  • If your tests stress the synthesis and evaluation of information, students will be motivated to practice those skills when they study.
  13. Avoid using grades as threats.
  • The threat of low grades may prompt some students to work hard, but other students may resort to academic dishonesty, excuses for late work, and other counterproductive behavior.
  14. Motivation: Help to motivate students, to see that they want to learn
  • Make your teaching interesting, lively, relevant and rewarding.
Assignment 
Unfortunately, there is no single magical formula for motivating students. Many factors affect a given student’s motivation to learn. Explain the 10 factors that motivate students to learn.

  1. 1. Relevance and Meaningful Learning: When students can see the relevance of what they are learning to their lives, interests, and future goals, they are more likely to be motivated to engage with the subject matter.

  2. 2. Autonomy and Choice: Allowing students to have some control over their learning, such as selecting projects or topics of interest, can enhance their motivation and sense of ownership in the learning process.

  3. 3. Clear Goals and Expectations: Setting clear and achievable learning goals helps students understand what is expected of them and provides a sense of direction, which can increase their motivation to accomplish those objectives.

  4. 4. Positive Learning Environment: A supportive and positive classroom or learning environment, where students feel respected, valued, and safe, can foster motivation and a willingness to participate actively.

  5. 5. Recognition and Rewards: Acknowledging and rewarding students’ efforts and achievements, both individually and collectively, can boost their confidence and motivation to excel in their studies.

  6. 6. Teacher Enthusiasm and Engagement: Teachers who show genuine enthusiasm for their subjects and actively engage students in the learning process can inspire excitement and curiosity, motivating students to learn.

  7. 7. Peer Interaction and Collaboration: Collaborative learning experiences and positive interactions with peers can create a sense of community and motivation to learn from and with others.

  8. 8. Intrinsic Curiosity and Interest: Cultivating curiosity and encouraging students to explore topics that fascinate them can lead to a natural desire to learn and discover more.

  9. 9 Feedback and Progress: Providing constructive and timely feedback on students’ work helps them understand their strengths and areas for improvement, contributing to their motivation to progress and grow.

  10. 10 Challenging Yet Attainable Tasks: Striking the right balance between challenging students with meaningful tasks and ensuring those tasks are achievable can foster a sense of accomplishment and motivation to take on new challenges.

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Proptosis

Proptosis / Exophthalmos

Proptosis

Proptosis of the eye, also known as exophthalmos, is a condition where one or both eyes bulge or protrude from their normal position in the eye sockets. 

It can be caused by various factors affecting the structures around the eyes. 

Causes and Risk Factors:

  1. Thyroid Eye Disease: One of the common causes of proptosis is thyroid eye disease, also known as Graves’ ophthalmopathy. It occurs when the immune system mistakenly attacks the tissues around the eyes, causing inflammation and pushing the eyes forward.

  2. Orbital Cellulitis and Infections: Infections in the eye socket, known as orbital cellulitis, can lead to swelling and proptosis.

  3. Orbital Tumors: Benign or malignant tumors in the eye socket can cause the eyes to bulge out. These growths need to be evaluated and treated promptly.

  4. Trauma or Injury: Severe injuries to the eye or orbit can displace the eye from its normal position, resulting in proptosis.

  5. Allergic Reactions: Severe allergic reactions in and around the eyes can cause swelling and push the eyes forward.

Risk Factors:

  • Thyroid disorders, such as hyperthyroidism (overactive thyroid)
  • Previous history of eye injuries or surgeries
  • Family history of thyroid eye disease or other eye conditions
  • Certain infections that can affect the eye socket and surrounding tissues

Classifications of Proptosis:

Proptosis, also known as exophthalmos, can be classified based on different criteria

Based on Onset:
a. Acute Proptosis: Sudden onset of bulging eyes, often associated with infections, trauma, or inflammatory conditions.
b. Chronic Proptosis: Gradual and persistent eye protrusion, frequently linked to conditions like thyroid eye disease or slow-growing tumors.

Based on Cause:
a. Thyroid-Related Proptosis: Caused by thyroid eye disease, usually associated with hyperthyroidism (Graves’ ophthalmopathy).
b. Inflammatory Proptosis: Resulting from infections or autoimmune disorders that lead to eye inflammation and swelling.
c. Neoplastic Proptosis: Caused by benign or malignant tumors within the orbit.
d. Traumatic Proptosis: Arising from injuries or fractures involving the eye and surrounding structures.
e. Allergic Proptosis: Due to severe allergic reactions affecting the eye and eye socket.

Based on Uni or Bilaterality:
a. Unilateral Proptosis: Affecting only one eye, often seen in localized conditions or trauma to one eye.
b. Bilateral Proptosis: Involving both eyes, commonly observed in systemic or thyroid-related causes.

Based on Severity:
a. Mild Proptosis: Minimal eye protrusion with no significant impact on vision or eye function.
b. Moderate Proptosis: Noticeable eye bulging with mild-to-moderate impact on eye movement and visual acuity.
c. Severe Proptosis: Pronounced eye protrusion with significant visual impairment, restricted eye movement, and potential complications.

Eye Structure: Anatomy of the eye

It consists of several important parts:

  1. Cornea: The clear front part that allows light to enter the eye.
  2. Iris: The colored part of the eye that controls the size of the pupil.
  3. Pupil: The black center that regulates the amount of light entering the eye.
  4. Lens: Located behind the iris, it focuses light onto the retina.
  5. Retina: The back of the eye where images are formed and sent to the brain through the optic nerve.
  6. Optic Nerve: Carries visual information from the retina to the brain for processing.

Orbit and Eye Socket:

The orbit, also called the eye socket, is a bony cavity in the skull that houses the eye and its surrounding structures. The orbit is made up of several bones, including the frontal bone, maxilla, zygomatic bone, and others. It not only protects the eye but also provides support and attachment points for the eye muscles.

Within the orbit, there are important soft tissues that include:

  1. Extraocular Muscles: These muscles control the movement of the eye in different directions.
  2. Fat Tissue: Provides cushioning and support for the eye within the orbit.
  3. Blood Vessels and Nerves: Supply nutrients and transmit sensory information to and from the eye.

Pathophysiology

Proptosis occurs when there is an abnormal increase in the volume of tissue within the orbit, causing the eye to bulge forward. This can happen due to swelling, growths, or displacement of structures within the eye socket. As a result of proptosis, the eye is pushed out of its normal position, which can lead to several effects:

  1. Visible Bulging: The affected eye(s) may appear more prominent than the other eye due to the forward displacement.
  2. Limited Eye Movement: Proptosis can hinder the normal movement of the eye because of the increased pressure within the confined space of the orbit.
  3. Exposure of the Eye Surface: The bulging eye may have difficulty closing fully, leading to problems with lubrication and dryness.
  4. Vision Problems: Proptosis can impact the alignment of the eyes, leading to double vision (diplopia) or blurred vision.
signs of Proptosis

Signs and Symptoms of Proptosis

A. Bulging or Protruding Eye(s): One of the most noticeable signs of proptosis is when one or both eyes appear to bulge or protrude from their normal position within the eye sockets. The affected eye(s) may look larger and more prominent than usual, which can be concerning for the person experiencing this symptom.

B. Redness and Swelling: Proptosis often leads to redness and swelling around the affected eye(s) and the surrounding tissues. The increased pressure within the eye socket can cause inflammation, making the eye area appear puffy and irritated.

C. Vision Changes and Diplopia (Double Vision): Changes in vision are common with proptosis. The displaced position of the eye can disrupt the normal alignment, leading to double vision (diplopia). This occurs when the images seen by each eye do not merge properly, resulting in two overlapping images instead of a single clear image.

D. Pain or Discomfort: Patients with proptosis may experience varying degrees of pain or discomfort around the affected eye(s) and the surrounding area. The pressure and stretching of tissues within the eye socket can cause pain, which may worsen with eye movement or touch.

E. Eyelid Abnormalities: Proptosis can affect the position and function of the eyelids. Some patients may experience difficulty fully closing the affected eye, leading to incomplete blinking and potential corneal exposure, which can cause dryness and irritation.

F. Photophobia (Light Sensitivity): Increased protrusion of the eye can make it more sensitive to light, leading to discomfort or pain when exposed to bright lights.

G. Watery Eyes: Proptosis can disrupt the normal tear flow and drainage, resulting in excessive tearing (epiphora).

H. Displacement of the Eye Muscles: The abnormal position of the eye may cause the extraocular muscles (responsible for eye movement) to become misaligned, leading to limited or abnormal eye movements.

I. Changes in Eye Appearance: Aside from bulging, proptosis may cause changes in the appearance of the eye(s), such as a widened palpebral fissure (the opening between the upper and lower eyelids) or changes in the position of the iris.

J. Pressure Sensation: Some individuals with proptosis may describe a feeling of pressure or heaviness around the eyes due to the increased tissue volume within the eye socket.

Diagnosing Proptosis

Diagnosis of Proptosis

Clinical Examination by Healthcare Professionals: The first step in diagnosing proptosis involves a thorough clinical examination by healthcare professionals, such as ophthalmologists or eye specialists. During the examination, the following assessments may be performed:

  1. Visual Acuity Test: To assess how well the patient can see at various distances using an eye chart.
  2. Eye Movement Examination: To check for any limitations or abnormalities in the movement of the affected eye(s).
  3. Pupil Examination: To evaluate the size and reaction of the pupils to light.
  4. Eye Pressure Measurement: To check for increased intraocular pressure, which may be associated with certain eye conditions.
  5. Slit-Lamp Examination: A specialized microscope used to examine the front structures of the eye, including the cornea, iris, and lens.
  6. Fundoscopy: To visualize the back of the eye (retina and optic nerve) using an ophthalmoscope.

Imaging Studies (MRI, CT Scan) for Accurate Assessment: Imaging studies are essential to get a detailed view of the eye and the structures within the orbit. The two most common imaging modalities used for proptosis diagnosis are:

  1. Magnetic Resonance Imaging (MRI): This non-invasive technique uses powerful magnets and radio waves to create detailed images of the eye, orbit, and surrounding soft tissues. MRI helps identify any abnormal growths, inflammation, or changes in the eye and orbital structures.

  2. Computed Tomography (CT Scan): CT scans provide cross-sectional images of the eye and orbit, offering precise information about the bony structures and any abnormalities present. It helps in identifying fractures, tumors, or other conditions affecting the eye socket.

Differential Diagnosis

  1. Thyroid Eye Disease (Graves’ Ophthalmopathy): This autoimmune condition is one of the common causes of proptosis and may be associated with other signs of hyperthyroidism.

  2. Orbital Cellulitis: An infection of the tissues around the eye, causing redness, swelling, and pain.

  3. Orbital Tumors: Benign or malignant growths that can push the eye forward.

  4. Allergic Reactions: Severe allergies can cause eye swelling and redness.

  5. Traumatic Eye Injury: Severe eye injuries may lead to eye displacement and proptosis.

Management of Proptosis

Medical Management:

  1. Treating Underlying Conditions (e.g., Thyroid Disorders): If proptosis is caused by an underlying condition like thyroid eye disease, the primary focus of treatment is managing the underlying disorder. For instance, in Graves’ ophthalmopathy, controlling the overactive thyroid with medications, radioactive iodine, or surgery may help stabilize or improve eye symptoms.

  2. Corticosteroids and Immunosuppressive Therapy: In certain cases of proptosis associated with inflammation or autoimmune conditions, corticosteroids may be prescribed. These anti-inflammatory medications help reduce swelling and inflammation around the eyes. In more severe cases, immunosuppressive therapy may be used to modulate the immune response and manage the underlying cause.

Surgical Interventions: (Pre and Post operative care)

  1. Orbital Decompression Surgery: Orbital decompression is a surgical procedure performed to alleviate pressure in the eye socket by creating additional space. It involves removing or reshaping parts of the bony orbit to allow the displaced eye to move back to a more normal position. This surgery is commonly used for patients with proptosis due to thyroid eye disease or other conditions causing compression of the optic nerve.

  2. Orbital Tumor Removal: If proptosis is caused by benign or malignant tumors within the orbit, surgical removal may be necessary. The goal is to excise the tumor while preserving the surrounding eye structures and restoring a more natural eye position.

  3. Eye Realignment Surgery: In cases of proptosis resulting from muscle imbalances or nerve problems, eye realignment surgery may be recommended. This procedure aims to reposition the affected eye(s) to improve alignment and reduce double vision.

Nursing Care for Patients with Proptosis

Patient Education:

  1. Understanding the Diagnosis and Treatment Plan: Nurses play a vital role in educating patients about their proptosis diagnosis, explaining the underlying cause, and discussing the treatment options available. They should ensure that patients comprehend the information, addressing any questions or concerns they may have.

  2. Eye Care and Hygiene: Nurses should provide guidance on proper eye care and hygiene practices to prevent complications like dry eyes and corneal exposure. This includes instructing patients on how to use lubricating eye drops, avoiding eye rubbing, and maintaining a clean eye area to reduce the risk of infections.

Monitoring and Assessment:

  1. Visual Acuity Checks: Regular visual acuity assessments should be performed to monitor changes in the patient’s vision. Record and report any abnomarities in visual acuity to the healthcare team promptly.

  2. Assessing for Complications: Monitoring for potential complications related to proptosis, such as signs of optic nerve compression, corneal exposure, and eye infections. Regular assessments can help detect these issues early, allowing for timely intervention.

Emotional Support for Patients and Families:

  1. Addressing Psychological Impact: Having proptosis can significantly impact a patient’s emotional well-being and self-esteem. Nurses should provide empathetic support, actively listen to patients’ concerns, and offer reassurance to help alleviate anxiety or distress related to the condition.

  2. Encouraging Coping Mechanisms: Nurses can recommend stress-reducing techniques and coping mechanisms to help patients manage their emotions and cope with the challenges of living with proptosis. Encouraging patients to engage in hobbies, relaxation techniques, or support groups can be beneficial.

  3. Positioning the Patient After Surgery: Following orbital surgeries, nurses will help position the patient to minimize swelling and promote comfort. Elevating the head of the bed and keeping the patient’s head elevated can help reduce post-operative swelling and pressure around the eyes.

Other measures, 

  • Lubricating Eye Drops: For patients experiencing dry eye symptoms due to incomplete eye closure, artificial tears or lubricating eye drops can help keep the eyes moist and reduce discomfort.

  • Eye Protection: Patients with proptosis should be advised to wear appropriate eye protection, such as safety glasses or goggles, to safeguard the eyes from potential injury.

  • Eye Patching: In cases where there is significant corneal exposure, eye patches may be used to protect the cornea and promote healing.

  • Vision Therapy: For patients with residual double vision, vision therapy exercises may be prescribed to help improve eye muscle coordination and reduce the impact of diplopia.

  • Psychological Support: Dealing with proptosis and its effects on appearance and vision can be emotionally challenging for patients. Providing psychological support and counseling can help patients cope with the condition and boost self-esteem.

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FIBROIDS (FIBROMYOMAS)

FIBROIDS (FIBROMYOMAS)


FIBROIDS (FIBROMYOMAS)

Fibroids are benign / non-cancerous tumors that originates from the
smooth muscle layer (myometrium) of the uterus.
Fibroids are benign tumors arising from the smooth muscle of the uterus.

 Other common names are :uterine leiomyoma, myoma, fibromyoma,
fibroleiomyoma.

They occur usually after the age of 30 years and commonly in women who have not had children. Fibroids are more likely to arise in the body of the uterus than the cervix. They are composed of muscle and fibrous tissue may be single or multiple and may be from a pinhead size to enormous size.


Risk factors for uterine fibroids

  1. Age: Uterine fibroids are more common in women between the ages of 30 to 40 years.

  2. Parity: Women who have never given birth (nulliparous) or have had few pregnancies (low parity) are at a higher risk.

  3. Race: Uterine fibroids are more prevalent in individuals of African descent (negro or black) compared to those of Caucasian (white) ethnicity.

  4. Family History: If a woman has close relatives (such as mother, sister) with a history of uterine fibroids, her risk may be increased.

  5. Hyper-estrogenemia: Elevated levels of estrogen, a female hormone, can promote the growth of fibroids.

  6. Obesity: Being overweight or obese is associated with a higher risk of developing uterine fibroids.

  7. Early Onset of Menarche: Starting menstruation at a young age may be linked to an increased likelihood of fibroid development.

  8. Low Level of Vitamin D: Some studies suggest that insufficient vitamin D levels might be associated with a higher risk of uterine fibroids.

  9. Drugs (Estrogen Replacement Therapy): Long-term use of estrogen replacement therapy, particularly without progesterone, can be a risk factor for uterine fibroids.



\"Classes

Classes or types of Uterine fibroids

  1. Submucosal Fibroids: These fibroids grow into the uterine cavity. They are located just beneath the inner lining of the uterus (endometrium). Submucosal fibroids can cause various symptoms, including heavy menstrual bleeding and infertility.

  2. Intramural Fibroids (Interstitial): Intramural fibroids are the most common type and grow within the muscular wall of the uterus, known as the myometrium. They may expand and distort the shape of the uterus, leading to pain, pressure, and other symptoms.

  3. Subserosal Fibroids: These fibroids grow on the outside surface of the uterus. They can project outward and may become quite large. Subserosal fibroids can cause pelvic pain and pressure on nearby organs.

  4. Cervical Fibroids: Located on the cervix, the lower part of the uterus, cervical fibroids are relatively rare. They may cause symptoms such as pain and discomfort, and in some cases, they can affect fertility or lead to difficulties during labor.

  5. Fibroid of the Broad Ligament: This type of fibroid develops in the broad ligament, which is a supportive structure that helps hold the uterus in place within the pelvis. Broad ligament fibroids are relatively uncommon and may require specific management depending on their size and location.

Location or Sites of Uterine Fibroids

The locations or sites of uterine fibroids can be described as follows:

I. Subperitoneal (Under the Peritoneal Surface): These fibroids grow on the outer surface of the uterus, just beneath the peritoneum (the thin, protective layer covering the abdominal organs). They can extend and project outward, leading to symptoms such as abdominal discomfort and pressure.

II. Submucous (Bulging/Protruding into the Endometrial Cavity): Submucous fibroids grow into the uterine cavity, bulging and protruding into the endometrial lining. They can cause heavy menstrual bleeding, irregular periods, and even affect fertility.

III. Pedunculated Fibroids: These fibroids are attached to the uterus by a narrow stalk or pedicle that contains blood vessels. Pedunculated fibroids can be either subserosal or submucous, depending on their location.

IV. Intramural (Within the Wall of the Uterus or Centrally within the Myometrium): Intramural fibroids are the most common type and grow within the muscular wall of the uterus (myometrium). They can cause the uterus to enlarge and lead to symptoms such as pelvic pain and pressure.

V. Subserosal (At the Outer Border of the Myometrium): Subserosal fibroids grow on the outer surface of the uterus, just beneath the serosa (the outermost layer of the uterus). These fibroids can be large and cause pelvic discomfort.

VI. Cervical Fibroids: Cervical fibroids are located on the cervix, the lower part of the uterus that connects to the vagina. They are relatively rare and can cause symptoms similar to other types of fibroids, such as pain and pressure.

Wondering what\’s the difference? 
The difference between \”types\” and \”location\” of uterine fibroids lies in what they describe:

  1. Types of Uterine Fibroids: The types of uterine fibroids refer to the different categories or classifications based on their specific characteristics and growth patterns. The main types of uterine fibroids are:
    a. Submucous (bulging into the endometrial cavity)
    b. Intramural (within the wall of the uterus or centrally within the myometrium)
    c. Subserosal (at the outer border of the myometrium)
    d. Pedunculated (attached to the uterus by a narrow stalk or pedicle)
    e. Cervical (located on the cervix)
    These types help healthcare professionals understand the nature of the fibroids and how they may be affecting the uterus and surrounding structures.
  2. Location of Uterine Fibroids: The location of uterine fibroids refers to the specific sites within or around the uterus where the fibroids are situated. The different locations are:
    a. Subperitoneal (under the peritoneal surface)
    b. Bulging/Protruding into the endometrial cavity (submucous)
    c. Attached to the uterus by a narrow pedicle containing blood vessels (pedunculated)
    d. In the wall of the uterus or centrally within the myometrium (intramural)
    e. At the outer border of the myometrium (subserosal)
    f. Cervical (located on the cervix)
    The location of the fibroids is crucial because it determines their proximity to other organs, how they may impact the uterine cavity or the cervical region, and how they might be approached for treatment.

In summary, the \”types\” of uterine fibroids describe the different categories based on their growth patterns, while the \”location\” refers to the specific sites within or around the uterus where the fibroids are found

Changes (degenerative) that can take place in the fibroid

Degenerative changes in uterine fibroids refer to alterations in the fibroid tissue that can occur over time or due to specific circumstances. 

  1. Red Degeneration: This type of degeneration often occurs during pregnancy. It happens when the fibroid\’s blood supply is disrupted, leading to necrosis (cell death) of the fibroid tissue. The fibroid becomes reddish and soft, with a \”beefy\” appearance.

  2. Atrophy: After menopause, when hormone production decreases, fibroids may undergo atrophy. Atrophy refers to a decrease in size or wasting away of the fibroid due to the reduction in hormonal stimulation.

  3. Hyaline Degeneration: In hyaline degeneration, the fibroid tissue becomes soft, and the muscle fibers are replaced by a homogenous, structureless material.

  4. Parasitic Fibroid: This occurs when the blood supply to a fibroid is cut off due to torsion (twisting) of its pedicle. The fibroid then establishes a new blood supply from the surrounding tissues.

  5. Cystic Change: Following hyaline degeneration, the fibroid\’s tissue can become fluid-filled, giving it a cystic appearance similar to an ovarian cyst.

  6. Fatty Change: The muscle fibers of the fibroid are replaced by fat tissue.

  7. Calcification: In calcification, calcium salts are deposited in the fibroid, causing it to harden and become similar to a stone.

  8. Eggshell Fibroid (Calcification): In this type of calcification, the calcium deposits form on the outside of the fibroid, leaving the inside with its usual consistency.

  9. Womb Stone: This term describes a fibroid that is entirely deposited with calcium salts, causing the entire fibroid to become hardened like a stone.


Causes of Uterine Fibroids.

Causes of uterine fibroids are not fully understood, but research suggests that hormones and genetics play significant roles in their development. Here\’s a more detailed explanation:

  1. Hormones: The hormones estrogen and progesterone, which regulate the menstrual cycle, have a close association with the growth and development of uterine fibroids. During each menstrual cycle, the lining of the uterus (endometrium) thickens under the influence of estrogen and progesterone. These hormones also seem to stimulate the growth of fibroids. As a result, fibroids often grow and enlarge during the reproductive years when hormone levels are at their highest. Conversely, as hormone production decreases during menopause, fibroids tend to shrink and become less symptomatic.

  2. Genetics: There is evidence to suggest that genetics can play a role in the development of uterine fibroids. Women with a family history of fibroids are at a higher risk of developing them themselves. This suggests that certain genetic factors may predispose individuals to fibroid formation.

  3. Other Factors: Although hormones and genetics are the main factors associated with uterine fibroids, some other factors may contribute to their development or growth. These factors include obesity, race (fibroids are more common in women of African descent), and dietary factors.

\"Clinical

Clinical Presentation of Uterine Fibroids.

  1. Painful and Prolonged Menstrual Periods: Fibroids can cause heavy and prolonged menstrual bleeding, leading to painful periods (dysmenorrhea).

  2. Vaginal Bleeding after Menopause: Postmenopausal women with fibroids may experience vaginal bleeding, which is abnormal after menopause.

  3. Difficulty with Urination and Constipation: Large fibroids or fibroids pressing on the bladder can cause frequent urination or difficulty emptying the bladder. Fibroids pressing on the rectum can lead to constipation.

  4. Pressure in the Pelvic Area: Women with fibroids may feel pressure or heaviness in the lower abdomen or pelvis.

  5. Fullness or Pressure in the Belly: Enlarged fibroids can cause the abdomen to appear distended and feel full.

  6. Lower Back and Leg Pain: Some women may experience lower back pain or pain in the legs due to the pressure exerted by fibroids on surrounding structures.

  7. Pain During Sex (Dyspareunia): Fibroids can cause pain or discomfort during sexual intercourse.

  8. Difficulty in Getting Pregnant (Infertility): Depending on their size and location, fibroids can interfere with the implantation of a fertilized egg or lead to difficulties in conception.

  9. Pressure Symptoms: Fibroids can create pressure on the bladder, leading to increased frequency of urination. They can also exert pressure on the rectum, causing constipation. Additionally, pelvic vein pressure can lead to hemorrhoids and varicose veins.

  10. Acute Degeneration: In some cases, fibroids may undergo acute degeneration, which can cause severe pain.

  11. Enlargement of the Abdomen: Large fibroids or multiple fibroids can cause the abdomen to become visibly enlarged due to their projection into the abdominal cavity.



\"investigations

Diagnosis and Investigations

  1. History Taking: A comprehensive medical history is taken to understand the patient\’s symptoms, menstrual patterns, reproductive history, and any relevant medical conditions. This helps in assessing the likelihood of uterine fibroids and guides further evaluation.

  2. Physical Examination: A physical examination is conducted to assess general health and look for specific signs related to uterine fibroids. This may include checking for signs of chronic anemia (pallor) due to heavy menstrual bleeding.

  3. Abdominal Examination: An abdominal examination is performed to detect any large pelvi-abdominal swelling, which can be associated with significant fibroid growth.

  4. Pelvic Examination: During a pelvic examination, the healthcare provider assesses the size, shape, and position of the uterus. Uterine fibroids may cause the uterus to be symmetrically or asymmetrically enlarged. A speculum examination may also reveal the presence of fibroid polyps.

  5. Investigations: Various diagnostic tests are used to confirm the presence of uterine fibroids and assess their characteristics. These investigations may include:

    • Pregnancy Test: To rule out pregnancy as a cause of symptoms.
    • Full Blood Count (FBC) and Iron Studies: To check for anemia, which can result from heavy menstrual bleeding caused by fibroids.
    • Pelvic Ultrasound (U/S): An ultrasound is a common imaging test used to visualize the uterus and detect fibroids. It is a non-invasive and relatively simple procedure.
    • Saline Hysterosonography: This procedure involves injecting saline into the uterus during an ultrasound to enhance visualization of the uterine cavity and identify submucous fibroids.
    • Hysterosalpingogram (HSG): An HSG is an X-ray procedure that uses contrast dye to visualize the uterine cavity and fallopian tubes. It can help detect intrauterine fibroids.
    • Transvaginal Ultrasound (TVUSS): This type of ultrasound involves inserting a small probe into the vagina for a clearer view of the pelvic organs, which can be especially useful in obese patients.
    • Hysteroscopy: A hysteroscope, a thin, lighted instrument, is used to directly visualize the uterine cavity, enabling the identification and removal of submucous fibroids.
    • Bimanual Examination: A two-handed examination of the pelvic organs to assess the size, shape, and mobility of the uterus and detect any abnormal masses.
    • MRI (Magnetic Resonance Imaging): Although not always necessary, MRI is highly accurate in providing detailed information about the size, location, and number of fibroids.

\"\"

Management of Fibroids.

Most fibroids do not require treatment unless they are causing symptoms. After menopause, fibroids usually shrink, and it is unusual for fibroids to cause problems. The choice of management depends on several factors:

  • Age
  • Parity
  • Size and location of fibroids
  • Desire for uterine preservation
  • If need for more children

For example:

  • Multiple myomas and completed childbearing benefit from hysterectomy.
  • Nulliparous women may undergo myomectomy.
  • Submucosal myomas can be treated with hysteroscopic resection.
  • Subserosal pedunculated myomas can be removed through laparoscopic resection.

Emergency Treatment:

  • Blood transfusion is given to correct anemia.
  • Emergency surgery is indicated for infected myoma, acute torsion, and intestinal obstruction.

Medical Management:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help manage pain.
  • Antifibrinolytic agents like tranexamic acid may reduce menorrhagia.
  • Low-dose birth control pills or an intrauterine device with a slow-release hormone (Mirena) can control heavy menstrual bleeding.
  • Haematenics like ferrous sulphate or folic acid are used to improve hemoglobin levels in cases of Menorrhagia.
  • Levonorgestrel intrauterine devices effectively limit menstrual blood flow and improve other symptoms with minimal side effects.
  • Gonadotropin-releasing hormone (GnRH) agonists like Lupron and Synarel can temporarily reduce estrogen and progesterone levels, leading to fibroid shrinkage.
  • Mifepristone (25-50mg twice weekly) is a progesterone receptor inhibitor that can reduce fibroid size and bleeding.
  • Danazol, an androgen, interrupts ovulation.

Surgical Management:

  • Myomectomy: Surgical removal of one or more fibroids, often recommended for women who want to preserve fertility.
  • Hysterectomy: Removal of the uterus, suitable for women with multiple myomas and completed childbearing.
  • Endometrial ablation: Removal of the uterine lining.
  • Uterine artery embolization: Limiting blood supply to the myoma by injecting polyvinyl particles via the femoral artery.
  • Radiofrequency ablation: Shrinking fibroids by inserting a needle-like device into the fibroid and heating it with radiofrequency.

Indications:

  • Myomectomy: Young women who want more children, small or few fibroids, heavy or prolonged bleeding.
  • Hysterectomy: Possible malignant changes, large or numerous fibroids, desire to limit family size, or approaching menopause.


Pre and Post Operative Care/Management

This involves providing care for patients undergoing  surgery of gynecological procedures. 

1. Admission and History Taking:

  • Obtain personal, medical, social, and gynecological history.
  • Conduct a physical examination, including vital signs (temperature, respirations, blood pressure, and pulse), head-to-toe examination to rule out anemia, dehydration, jaundice, and vaginal examination to assess any abnormalities.
  • General assessment by the gynecologist.

2. Informed Consent:

  • Explain the reasons for the operation, its benefits, risks, and expected results to the patient and involve the partner if necessary.

3. Investigations:

  • Conduct various tests, including urinalysis, hemoglobin (HB) level, blood grouping and cross-match, abdominal ultrasound scan, urea and electrolytes, INR/PT (International Normalized Ratio/Prothrombin Time), and ECG/ECHO if required.

4. Patient Education:

  • Educate the patient about the surgery, its purpose, potential complications, and side effects of anesthesia.
  • Provide reassurance and counseling to relieve anxiety.

5. Preparing for Surgery:

  • Ensure the patient fasts from food and drinks on the day of the operation.
  • Arrange for IV line insertion, blood booking in the laboratory, and catheterization of the patient.
  • Administer pre-medications as prescribed.

6. Assisting with Theatre Preparation:

  • Help the patient change into theatre gown.
  • Continue providing counseling and emotional support.
Post-Operative Management:
  • After the operation, prepare the post-operative bed for the patient.
  • Obtain reports from the surgeon, recovery room nurses, and anesthetists.
  • Wheel the patient to the ward.
  • Receive the patient in a warm bed, keeping her in a flat position, or turning her to one side depending on the surgery type (supine for abdominal surgery or a comfortable position for vaginal surgery).

Observation:

  • Monitor the patient closely, taking vital signs regularly (every ¼ hr for the first hour and every ½ hr for the next hour until discharge).
  • Observe temperature, pulse, respiration, blood pressure, and signs of bleeding or edema at the surgical site.
  • Check the IV line and blood transfusion line if applicable.

Upon Consciousness:

  • Gently welcome the patient from the theater, explain the surgery, and assist with face sponging.
  • Provide a mouthwash and change the gown.

Medical Treatment:

  • Administer analgesics, such as Pethidine 100mg every 8 hours for 3 doses, and switch to Panadol to complete 5 days.
  • Prescribe antibiotics, such as ampicillin or gentamicin, as ordered.
  • Offer supportive care with vitamins like vitamin C, iron, and folic acid.
  • Monitor and care for the wound in case of abdominal surgery, leaving the wounds untouched if bleeding occurs and re-bandaging if necessary.

Nursing Care:

  • Assist the patient with hygiene, including bed baths and oral care.
  • Allow the patient to feed herself as soon as she is able and provide plenty of fluids.
  • Encourage regular bowel and bladder emptying, offering assistance as needed.
  • Initiate chest and leg exercises to avoid swelling and bleeding in the wound.
  • Gradually increase the exercise routine to prevent deformities and contractures.

Vaginal Surgery Management:

  • Insert a vaginal pack to control hemorrhage and inspect it frequently for severe bleeding.
  • Apply vulval padding after pack removal until bleeding stops, changing it when necessary to prevent infections.
  • Swab or clean the vulva at least every 8 hours to prevent infection.

Advice on Discharge:

  • For Myomectomy patients, advise avoiding conception for 2 years following the operation and delivering via cesarian section.
  • For hysterectomy patients, inform them that they will not conceive again or have periods.
  • Recommend abstaining from sexual intercourse for about 6 weeks and avoiding douching. Vaginal bleeding may persist for up to 6 weeks.

Complications of Uterine Fibroids:

  • Menorrhagia (heavy menstrual bleeding)
  • Premature birth, labor problems, and miscarriage
  • Infertility
  • Twisting of the fibroids
  • Anemia
  • Urinary tract diseases
  • Postpartum hemorrhage

Complications during pregnancy and labor may include:

  • Antepartum hemorrhage (placenta previa, placental abruption)
  • Abortion
  • Fetal restricted growth
  • Malpresentation
  • Cesarean section
  • Labor dystocia
  • Premature labor
  • Uterine inertia leading to postpartum hemorrhage
  • Obstructed labor
  • Subinvolution of the uterus with increased lochia.


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