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HAZARD PREVENTION AND CONTROL

Hazard prevention is any workplace-specific program designed to stop the occupancy or occurrence of work-related injuries and diseases.

Hazard control refers to the implementation of policies, standards, procedures and physical changes to eliminate or minimize adverse risks.

Hazards are anything that can cause harm to workers, such as injuries, illnesses, or accidents.

Hazard Identification: This is the initial step in the risk assessment process. It involves recognizing and listing potential hazards that may exist in a given environment.

Hazard identification is the process of identifying, locating, and documenting anything that could cause harm, damage, injury, or adverse effects. This step is more qualitative and involves recognizing what hazards could be present.

Methods of hazard control/Hierarchy of Controls at the workplace

There are different methods of hazard prevention and control, which can be ranked according to a hierarchy of effectiveness. The higher the level in the hierarchy, the more effective the method is. The hierarchy of controls is as follows:

Elimination: Eliminating the Risk (Level One): This is the most effective method, as it removes the hazard completely from the workplace. For example, cleaning spills from the floor immediately or replacing worn-out equipment or wires eliminates the risk of slips, trips, or electric shocks.
Substitution: Substituting the Risk (Level Two): This is the second most effective method, as it replaces a hazard with a less hazardous one. For example, using single-use syringes instead of re-usable ones reduces the risk of infection. However, substitution may introduce new hazards, so a new risk assessment should be done after the change.
Isolation: Isolate the Risk (Level Three): This is the third most effective method, as it separates workers from the hazard by using barriers or distance. For example, placing dangerous machinery in a separate room and installing remote control systems isolates workers from the risk of injury. Another example is using isolation rooms for patients with contagious diseases.
Engineering controls: Engineering Controls (Level Four): Engineering risk control is the process of designing and installing additional safety features to workplace equipment. These are physical modifications or additions to equipment or the work environment that reduce exposure to hazards. For example, installing ventilation systems in areas with harmful gasses or dust or guardrails on raised walkways reduces the risk of respiratory problems or falls.
Administrative controls: Administrative Controls (Level Five): These are rules, policies, procedures, or training that aim to change workers’ behavior or work practices to avoid or reduce hazards. For example, providing safety training on how to use equipment properly or arranging work schedules to limit exposure time in hazardous areas reduces the risk of human error or fatigue.
Personal protective equipment (PPE): Personal Protective Equipment (Level Six): These are items that workers wear or use to protect themselves from hazards, such as hard hats, ear plugs, gloves, masks, etc. This is the least effective method in the hierarchy, as it does not remove or reduce the hazard itself. It only protects workers from harm if an incident occurs. Therefore, PPE should always be used in combination with other methods and as a last resort.

Considerations for Effective Control and Prevention of Hazards

Involve workers in the process. Workers often have the best understanding of the hazards in the workplace and how they can be controlled.
Identify and evaluate options for controlling hazards. Use a “hierarchy of controls” to select the most effective and permanent controls. The hierarchy of controls prioritizes engineering controls (such as eliminating or substituting hazards) over administrative controls (such as work practices) and personal protective equipment (PPE).
Use a hazard control plan to guide the selection and implementation of controls. The hazard control plan should describe how the selected controls will be implemented and who is responsible for their implementation.
Develop plans to protect workers during non-routine operations and emergencies. These plans should include procedures to control hazards that may arise during non-routine operations, such as maintenance and repair, and during emergencies, such as fires and explosions.
Implement selected controls in the workplace. Implement the controls according to the hazard control plan and track progress to ensure that they are effective.
Follow up to confirm that controls are effective. Track progress in implementing the controls, inspect and evaluate the controls once they are installed, and follow routine preventive maintenance practices.

Prevention of Occupational Health Hazards

There are three levels of prevention of occupational health hazards: primary prevention, secondary prevention, and tertiary prevention.

Primary Prevention

Primary prevention aims to prevent the exposure to hazards in the first place. This can be done through a variety of measures, including:

Health education: Educating workers about the hazards in their workplace and how to protect themselves.
Pre-employment medical screening: Screening workers for health conditions that may make them more susceptible to hazards.
Establishing and enforcing health and safety regulations: Ensuring that workplaces are safe and that workers are following safe work practices.
Providing personal protective equipment: Providing workers with personal protective equipment (PPE) to protect them from hazards.
Engineering controls: Designing workplaces to reduce or eliminate hazards.

Secondary Prevention

Secondary prevention aims to identify and treat health problems early, so that they do not become more serious. This can be done through a variety of measures, including:

Health surveillance: Regularly monitoring workers’ health for signs of occupational health problems.
Health screening: Testing workers for specific health problems that may be related to their work.
Treatment: Providing workers with treatment for occupational health problems.

Tertiary Prevention

Tertiary prevention aims to minimize the effects of occupational health problems that have already occurred. This can be done through a variety of measures, including:

Rehabilitation: Helping workers who have been injured or disabled by occupational health problems to return to work.
Compensation: Providing financial compensation to workers who have been injured or disabled by occupational health problems.
Prevention of further injury or disability: Taking steps to prevent workers from being injured or disabled again.

Occupational hazard assessment

Occupational hazard assessment is the routine examination of; sites, equipment and human resource to ensure prevention of occurrence of an occupational hazard

Importance of Occupational Hazard Assessment.

This assessment is of importance to;

Employer
Employees
And community

Employer:

Compliance with regulations: Occupational hazard assessment helps employers comply with legal and regulatory requirements related to workplace safety. By identifying and mitigating hazards, employers demonstrate their commitment to providing a safe working environment.
Risk management: Assessing occupational hazards enables employers to identify potential risks and implement appropriate control measures. This proactive approach reduces the likelihood of workplace accidents, injuries, and related financial liabilities.
Enhanced productivity: A safe and healthy work environment promotes employee well-being, job satisfaction, and morale. By conducting hazard assessments, employers can address risks and create a conducive workplace, leading to improved productivity and efficiency.
Reputation and credibility: Employers who prioritize occupational hazard assessment showcase their commitment to employee safety and welfare. This enhances their reputation, builds trust among employees and stakeholders, and helps attract and retain talented workers.

Example: A manufacturing company conducts regular hazard assessments in its production facility. During one assessment, they identify potential risks associated with outdated machinery. As a result, the employer invests in upgrading the equipment to improve worker safety and efficiency. This approach not only minimizes the risk of accidents and injuries but also demonstrates the employer’s commitment to employee well-being and compliance with safety regulations.

Employee:

Personal safety: Occupational hazard assessments prioritize employee safety by identifying and addressing potential workplace hazards. Employees can work with peace of mind, knowing that their well-being is valued, and appropriate measures are in place to mitigate risks.
Health and well-being: Identifying and controlling hazards through assessments promotes employee health and well-being. By reducing exposure to occupational risks, employees are less likely to develop work-related illnesses or injuries, leading to improved overall health and quality of life.
Empowerment and involvement: Involving employees in hazard assessments empowers them to actively participate in maintaining a safe work environment. It allows them to contribute their insights and concerns, fostering a culture of safety and ownership within the organization.
Confidence and job satisfaction: Employees who feel safe and protected in their work environment experience higher job satisfaction and are more engaged in their roles. Occupational hazard assessments contribute to this sense of confidence, leading to increased employee retention and loyalty.

Example: In a construction company, hazard assessments are conducted before each new project. During one assessment, potential fall hazards are identified, leading to the implementation of safety measures such as providing harnesses and guardrails. By involving employees in the assessment process and addressing their safety concerns, the company empowers its workers, instilling confidence and job satisfaction.

Community:

Public safety: Occupational hazard assessment benefits the community by ensuring that workplaces operate in a manner that does not pose risks to public safety. Preventing accidents and incidents at work contributes to the overall well-being of the community.
Environmental protection: Hazard assessments often include evaluating the environmental impact of work processes. By identifying and controlling hazards that could harm the environment, occupational hazard assessments contribute to sustainable and responsible practices.
Community perception: Companies that prioritize occupational hazard assessments demonstrate their commitment to responsible business practices. This positive perception enhances community trust and goodwill toward the organization, fostering positive relationships and potentially attracting community support.

Example: An oil refinery conducts regular hazard assessments to ensure the safety of its operations. During an assessment, they identify potential risks related to chemical spills that could harm the surrounding environment and nearby communities. The refinery invests in advanced containment systems and implements stringent protocols to prevent such incidents. By prioritizing occupational hazard assessment, the company safeguards the community from environmental harm and builds trust and goodwill.

Methods of Hazard Identification, Prevention, and Control

Human Resource

Pre-placement/pre-employment medical examination: This examination has three aims:
- To determine the suitability of an applicant for a particular job, from the viewpoints of both the risk to the applicant’s health and safety, and the risk to other workers and members of the community.
- To detect untreatable pathological conditions and asymptomatic diseases.
- To provide a baseline record against which any future findings or routine examinations can be compared.
Periodic examinations: These examinations are conducted to detect adverse trends caused by work.
Special physical examinations: Every worker should have a physical examination before being allowed to return to work following an illness, and also following signs of difficulty to cope with work, and among those with chronic illnesses.

Equipment and Workplace/Site

Routine maintenance and servicing of equipment: This helps to identify and correct potential hazards before they cause an accident.
Repair and replacement of equipment: This ensures that equipment is in good working order and does not pose a hazard to workers.
Provision of standard operating protocols: These protocols provide clear instructions on how to operate equipment safely.
Routine drills to employees: These drills help employees to learn how to respond to emergencies in a safe and effective manner.
Provision of protective wears: This includes items such as safety glasses, hard hats, and gloves, which can help to protect workers from injury.
Installation of warning posters in work environment and restriction of access to some areas: This helps to keep workers safe by warning them of potential hazards and restricting access to areas where there is a risk of injury.
Standard training of employees before employment and handling of new machinery: This training helps employees to learn how to operate equipment safely and to identify and avoid hazards.
Installation of fire extinguishers: This helps to prevent the spread of fire and to protect workers from burns.
Provision of sanitary points such as hand washing equipment: This helps to prevent the spread of infection.
Assembly points: These points are designated areas where workers can gather in the event of an emergency.

Steps in Occupational Hazard Assessment and Identification

Occupational hazards are any sources of potential damage, harm or adverse effects on the health and safety of workers or the environment. Occupational hazard assessment and identification is the process of finding, recognizing, and describing the hazards that exist in the workplace, and analyzing and evaluating the risks associated with these hazards. The purpose of this process is to prevent or reduce the occurrence and severity of work-related injuries, illnesses, and fatalities.

The following are some steps that can be followed to conduct occupational hazard assessment and identification:

1. Collect existing information about workplace hazards

Before inspecting the workplace for hazards, it is useful to gather and review any information that may already be available from both internal and external sources. This can include:

Inspecting the work place for safety: Records of previous incidents, injuries, illnesses, near misses, complaints, or suggestions related to workplace hazards
Identify hazards: Safety data sheets , labels, manuals, or instructions for hazardous products or equipment used in the workplace.
Conducting incident investigations: Regulations, standards, codes of practice, or guidelines that apply to the workplace or the industry
Reports or publications from professional associations, research institutions, government agencies, or other organizations that provide information on workplace hazards
Input from workers, supervisors, managers, health and safety committees, unions, or other stakeholders who have knowledge or experience of the workplace hazards

The collected information should be organized and reviewed with workers to determine what types of hazards may be present and which workers may be exposed or potentially exposed. This can help identify areas or activities that need more attention during the inspection.

2. Inspect the workplace for safety hazards

Even if some information on workplace hazards is already available, it is still important to inspect the workplace regularly for any new or existing hazards that may have been overlooked or introduced over time. Hazards can arise from changes in workstations, processes, equipment, tools, materials, or environment. They can also result from poor maintenance, housekeeping, or training practices.

A workplace inspection involves observing the physical conditions and work activities in the workplace, and identifying any hazards that could cause harm to workers or the environment. Some common methods of inspecting the workplace are:

Walking around the workplace and looking for any obvious signs of hazards, such as spills, leaks, broken equipment, exposed wires, blocked exits, etc.
Talking to workers and asking them about any concerns or issues they have regarding their work environment, tasks, equipment, tools, materials, etc.
Using checklists or forms to guide the inspection process and ensure that all relevant aspects of the workplace are covered
Taking notes, photos, videos, measurements, samples, or other records of the observed hazards and their locations

Workers can be a very useful internal resource for inspecting the workplace for hazards, especially if they are trained in how to identify and assess risks. Workers have firsthand knowledge of their work conditions and tasks, and may be aware of some hazards that are not obvious to others. Involving workers in the inspection process can also increase their awareness and participation in health and safety matters.

3. Identify hazards associated with emergency and non-routine situations

In addition to inspecting the workplace for regular hazards that occur during normal operations, it is also necessary to identify any hazards that may arise during emergency or non-routine situations. These are situations that are not part of the usual work activities or procedures, but may occur unexpectedly or occasionally due to various factors. Some examples of emergency or non-routine situations are:

Fire
Explosion
Chemical spill
Power outage
Natural disaster
Equipment failure
Maintenance work
New project
Temporary assignment

Emergency or non-routine situations can pose different or additional risks to workers or the environment than those encountered during normal operations. Therefore, it is important to identify these risks beforehand and prepare appropriate measures to prevent or respond to them effectively.

Some ways to identify hazards associated with emergency or non-routine situations are:

Reviewing past incidents or near misses that involved emergency or non-routine situations
Consulting with experts or specialists who have knowledge or experience of dealing with emergency or non-routine situations
Conducting scenario analysis or simulation exercises to anticipate potential outcomes and consequences of emergency or non-routine situations
Developing emergency plans or procedures that outline the roles and responsibilities of workers and other parties in case of emergency or non-routine situations

4. Characterize the nature of identified hazards, identify interim control measures, and prioritize the hazards for control

After identifying all the possible hazards in the workplace, it is necessary to characterize their nature, identify interim control measures, and prioritize them for control.

Characterizing the nature of identified hazards means describing their sources, forms, effects, and severity. This can help determine how likely they are to cause harm, and how serious the harm could be. Some factors that can be used to characterize the nature of identified hazards are:

Frequency: how often the hazard occurs or is encountered
Duration: how long the hazard lasts or is exposed
Magnitude: how large or intense the hazard is
Probability: how likely the hazard is to cause harm
Severity: how serious the harm could be

Identifying interim control measures means taking temporary actions to reduce or eliminate the risk of harm from the identified hazards until permanent solutions can be implemented. Interim control measures can include:

Isolating or removing the hazard from the workplace or workers
Providing personal protective equipment (PPE) or other safety devices to workers
Posting warning signs or labels to alert workers of the hazard
Implementing administrative controls, such as limiting access, exposure, or work hours to the hazard
Providing training, information, or instruction to workers on how to avoid or handle the hazard

Prioritizing the hazards for control means ranking the identified hazards according to their level of risk and urgency of action. This can help allocate resources and plan interventions more effectively and efficiently. Some criteria that can be used to prioritize the hazards for control are:

Legal requirements: whether the hazard violates any laws, regulations, standards, or codes of practice that apply to the workplace or the industry
Worker concerns: whether the hazard affects a large number of workers or causes significant distress or dissatisfaction among workers
Cost-benefit analysis: whether the benefits of controlling the hazard outweigh the costs of doing so
Hierarchy of controls: whether the hazard can be controlled by using more effective and reliable methods, such as elimination, substitution, engineering controls, administrative controls, or PPE

Note: Many hazards can be identified using common knowledge and available tools. For example, you can easily identify and correct hazards associated with broken stair rails and frayed electrical cords. Workers can be a very useful internal resource, especially if they are trained in how to identify and assess risks

Good safety Practices

Good safety practices are the actions that can be taken to prevent accidents and injuries in the workplace. They can help to create a safe and healthy environment for employees

Provide regular safety training. This training should cover all aspects of workplace safety, including how to identify and avoid hazards, how to use personal protective equipment (PPE), and how to respond to emergencies.
Encourage employees to report hazards. Employees should feel comfortable reporting any hazards they see, no matter how small they may seem. Employers should have a system in place for employees to report hazards and should investigate all reports promptly.
Provide PPE. The right PPE can help protect employees from injury. Employers should provide PPE that is appropriate for the hazards in the workplace and should ensure that employees know how to use it properly.
Maintain equipment and facilities. Equipment and facilities should be regularly inspected and maintained to ensure that they are safe to use. Employers should also have a system in place for reporting and correcting unsafe conditions.
Create a culture of safety. Employers should create a culture of safety in the workplace where employees feel valued and respected. This means creating a workplace where employees feel comfortable speaking up about safety concerns and where they are not afraid to take risks.
Hold regular safety meetings. These meetings should be used to discuss safety issues and to remind employees of the importance of safety. They should also be used to share information about new hazards or changes to safety procedures.
Enforce safety rules. Safety rules are in place to protect employees. Employers should enforce these rules consistently and fairly.
Provide incentives for safety. Employers should provide incentives for safety, such as rewards for employees who have a good safety record. This can help to encourage employees to be more safety conscious.
Celebrate safety successes. When employees do something to improve safety, employers should celebrate their success. This can help to reinforce the importance of safety and to encourage employees to continue to work safely.
Make safety a priority. Safety should be a top priority for employers. This means providing the resources and support necessary to create a safe workplace.

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OCCUPATIONAL HEALTH HAZARDS

In the field of occupational health, it is important to understand the concept of hazards and risks associated with the workplace. The following definitions and processes help in identifying and controlling these hazards:

Hazard: A hazard refers to a situation in the workshop that has the potential to cause harm, such as personal injury, disease, or even death.
Risk: Risk is the probability or chance of a hazard leading to actual injury, disease, or death.
Hazard identification: This process involves actively identifying all possible situations in the workplace where individuals may be exposed to risks of injury, disease, or death.
Hazard control: Hazard control entails implementing policies, standards, procedures, and making physical changes to the workplace to eliminate or minimize the adverse risks.

Classification of Workplace Hazards

Workplace hazards can be categorized into different types.

Physical Hazards: These hazards are associated with physical factors in the workplace, such as noise, vibration, radiation, temperature extremes, and ergonomic stressors. They can cause direct harm to workers’ physical well-being.
Mechanical Hazards: Mechanical hazards arise from machinery, equipment, or processes that can lead to injuries, such as crushing, cutting, or shearing. Examples include unguarded machinery, faulty equipment, or inadequate machine maintenance.
Chemical Hazards: Chemical hazards encompass exposure to hazardous substances in the workplace, including toxic chemicals, gases, fumes, or flammable materials. Exposure can occur through inhalation, ingestion, or skin contact, potentially resulting in poisoning, respiratory issues, or chemical burns.
Biological Hazards: Biological hazards are associated with exposure to living organisms or their byproducts, such as bacteria, viruses, fungi, or parasites. These hazards are common in healthcare settings, laboratories, or agricultural environments, and can lead to infectious diseases or allergic reactions.
Ergonomic Hazards: Ergonomic hazards arise from work tasks, equipment, or the workplace layout that can cause musculoskeletal disorders or physical strain. Poor posture, repetitive movements, lifting heavy objects, or poorly designed workstations can contribute to ergonomic hazards.
Psychosocial Hazards: Psychosocial hazards involve factors related to the social and psychological aspects of work. They include stress, work-related violence, bullying, harassment, or excessive workload, which can have detrimental effects on mental and emotional well-being.

Physical Hazards

Physical hazards in the workplace are associated with elements that can cause harm due to their physical characteristics. Examples of physical hazards include:

Work at Height: Working at elevated levels without proper fall protection measures.
Vibration: Exposure to excessive vibrations, such as from handheld tools or machinery, leading to musculoskeletal disorders.
Noise: Excessive levels of noise that can result in hearing loss or other hearing-related issues.
Heat: Extreme temperatures in the workplace that can lead to heat stress, heat stroke, or cold stress.
Trip Hazards: Objects or conditions that can cause individuals to trip and fall, such as uneven surfaces or cluttered walkways. (when you trip or slip but do not actually fall is called near miss)
Poor Illumination: Insufficient lighting that can lead to reduced visibility and potential accidents.
Radiation:
a. Non-ionizing radiation:

Ultraviolet radiation: Exposure in welding, metal cutting, or carbon arc can cause skin erythema, burns, and eye-related issues. Protection with special face shields and goggles is necessary.
Infrared radiation: Exposure in front of furnaces, steel mills, or glass industry settings can lead to eye and skin problems. Special goggles can provide complete eye protection.

b. Ionizing radiation: Sources include radioactive isotopes and X-ray machines, posing risks such as increased probabilities of certain cancers and cataracts.

Effects of Physical Hazards on Individuals in the Workplace

1. Extreme temperatures:

Lassitude, irritability, and discomfort.
Reduced work performance and lack of concentration.
Heat rash, heat exhaustion, and heat stroke.

2. Noise pollution: Noise-induced hearing loss.

3. Vibration: Vascular disorders in the arms and bony changes in the wrist bones.

4. Radiation exposure: Increased risks of mutation, certain cancers, and cataracts.

5. Poor illumination: Loss of sight due to poor light adaptation.

6. Atmospheric pressure: Increased pressure underwater can cause aseptic bone necrosis around the knee, hip, and shoulder.

7. Occupational exposure to physical factors (e.g., ionizing radiation) can affect reproductive functions, leading to dysfunction, increased incidence of miscarriage, stillbirth, neonatal death, and defects in newborn babies.

Prevention of Physical Hazards

Controls to reduce the risk of slips, trips, and falls include:

Keeping hallways clear of obstructions.
Using non-slippery surfaces on stairs or at least on the leading edges.
Regular maintenance to keep stairs in good repair, ensuring no protruding objects.
Maintaining proper lighting levels.
Utilizing angular lighting and color contrast to improve depth perception.
Educating workers and enforcing the use of proper footwear.
Promptly cleaning up spills.
Eliminating tripping hazards such as extension cords.
Keeping walkways free of clutter.

Preventing Electrical Hazards Considerations for using extension cords:

Protect cords from damage.
Unplug extension cords when not in use.
Avoid using damaged extension cords.
Never modify extension cord plugs.
Do not chain multiple extension cords together; use a single cord of sufficient length.

Sharp Hazards

Use safety cutters as bag and box openers.
Proper storage and disposal of sharp objects like in safety boxes.

Measures to Control Noise in the Workplace:

Design and maintain machinery to reduce noise levels.
Segregate and disperse noise sources.
Use soundproofing materials for floors, walls, and ceilings.
Rotate workers to minimize exposure.
Reduce work exposure hours.
Provide personal protective devices such as earplugs, earmuffs, and helmets.

Control of Exposure to External Radiation Sources:

Control of exposure to external radiation sources rests on three general principles:

Maintain sufficient distance between the source and workers.
Minimize time of exposure.
Implement containment and shielding measures.

Conduct environmental monitoring and provide alarm systems.
Perform pre-placement and periodic medical examinations with emphasis on eyes, skin, and blood.
Provide personal protective clothing.
Use personal monitoring badges, pocket dosimeters, and whole-body counters.

Chemical Hazards

Chemical hazards are substances that can cause harm due to their chemical composition characteristics. These hazards can exist in the form of gasses or liquids.

Types of Chemical Hazards.

Asphyxiants: These gasses can cause asphyxia by displacing oxygen or by affecting the respiratory tract system.
Irritant gasses: Gasses that can cause irritation or inflammation of the mucous membranes upon contact.
Organo-metallic compounds (e.g., Nickel carbonyl Ni (CO)4): Volatile liquids produced during nickel extraction. Exposure to these compounds can result in hemolysis, anemia, jaundice, and severe cases may lead to anuria.
Anesthetic vapors: Many of these substances have systemic effects and tend to accumulate in low, poorly ventilated spaces.
Metals: Examples include lead, mercury, manganese, and arsenic.
Dust: Fine particles that can be hazardous when inhaled.

Effects of Chemical Hazards

Silicosis: Caused by inhalation of respirable particles of free crystalline silica.
Asbestosis: Resulting from the inhalation of asbestos fibers, a material once widely used in building materials.
Lung cancer: Many chemicals are known to cause lung cancer, including asbestos and some types of silica.
Chronic obstructive pulmonary disease (COPD): This is a group of lung diseases that cause airflow blockage and breathing difficulties.
Asphyxiation: Some chemicals can prevent the body from getting enough oxygen, leading to suffocation.
Systemic intoxication:This is a general poisoning of the body.
Carcinogens: Chemicals that can cause cancer.
Irritation: Some chemicals can irritate the skin, eyes, or respiratory system.
Mutagenicity: Chemicals that can cause mutations (changes) in DNA, which can lead to cancer or other health problems.

Occupational exposure to certain chemicals or physical factors (like ionizing radiation) has been found to have certain effects on reproductive functions:

Dysfunction in males (sterility or defective spermatozoa) and females (anovulation, implantation defects in the uterus)
Increased incidence of miscarriage, stillbirth and neonatal death
Induction of structural and functional defects in newborn babies

Prevention of Chemical Hazards

To prevent chemical hazards, safe work procedures should be implemented:

Limit the worker’s exposure time.
Reduce contact with the hazardous substance through any route of exposure.
Ensure safe disposal of substances and disposable equipment that come into contact with harmful substances.
Ensure safe handling and decontamination of reusable equipment.

Precautions for potential exposure to noxious gasses include:

Ventilation of workplaces.
Provision of gas masks if there is a likelihood of noxious gasses or insufficient oxygen.
Proper training of workers, working in teams with designated observers at a safe distance.
Availability of first aid equipment and trained rescuers.
Prompt removal of affected workers from exposure, providing warmth and rest. Artificial respiration should be administered if breathing stops.

Dust control measures include:

Segregation of dusty jobs.
Enclosure of dusty operations.
General and local exhaust ventilation.
Proper housekeeping and cleanliness.
Use of water for dust suppression.
Personal cleanliness, washing facilities, changing work clothes, separate areas for eating, drinking, and smoking in the case of toxic dust.
Health education.
Pre-placement medical examination.
Use of personal protective equipment.

Mechanical Hazards

Mechanical hazards in the workplace encompass unshielded machinery, unsafe structures, and dangerous, unprotected tools. These factors pose risks to the safety of individuals.

Effects of Mechanical Hazards

Occupational accidents, primarily due to contact with machinery or tools.
Bruises on different parts of the body.
Subcutaneous cellulitis, an infection of the skin and underlying tissues.

Prevention of Mechanical Hazards

Machine Guarding: Install appropriate guards on machinery to protect workers from moving parts, rotating equipment, and other hazardous components.
Safety Training: Provide training programs for employees to educate them about the potential mechanical hazards in their work environment. Train them on safe work practices, proper use of tools and equipment, and the importance of following safety protocols.
Regular Equipment Maintenance: Establish a regular maintenance schedule to inspect and maintain machinery and equipment. This includes checking for wear and tear, loose parts, and any potential hazards. Promptly address any identified issues to prevent accidents.
Personal Protective Equipment (PPE): Ensure that appropriate PPE, such as gloves, safety glasses, hard hats, is provided to workers. Train employees on the correct use and maintenance of PPE and enforce its consistent usage.
Hazard Identification and Risk Assessment: Conduct regular hazard assessments to identify potential mechanical hazards in the workplace.
Safe Work Practices: Establish and enforce safe work practices and standard operating procedures (SOPs) for tasks involving machinery and equipment. These practices should include guidelines for proper use, maintenance, and storage of tools and machinery.
Emergency Preparedness: Develop and communicate emergency procedures in the event of mechanical hazards, such as equipment malfunctions or unexpected incidents. Ensure workers are aware of emergency exits, evacuation routes, and emergency contact information.
Regular Inspections: Conduct routine inspections of work areas to identify potential mechanical hazards. Encourage workers to report any hazards or concerns they observe and address them.
Employee Engagement(Safety Culture): Foster a culture of safety by involving employees in the identification and resolution of mechanical hazards.

Biological Hazards

Biological hazards involve viruses, bacteria, fungi, parasites, or any living organisms capable of causing diseases in humans.

Transmission of Biological Hazards

Inhalation: Breathing in airborne pathogens.
Injection: Entry of pathogens through puncture wounds or contaminated sharps.
Ingestion: Swallowing pathogens through contaminated food, water, or objects.
Contact with the skin: Direct contact with infected materials or surfaces.

Effects of Biological Hazards

Infections: Contracting diseases caused by pathogens.
Diseases: Developing specific illnesses due to exposure to biological hazards.
Reduced productivity at work: Illnesses can result in decreased work performance and absenteeism.
Disability: Severe cases of diseases caused by biological hazards can lead to long-term impairments.

The Contract of Biohazard: The severity of exposure to biological hazards depends on:

The concentration or number of organisms present in the environment.
The virulence of these organisms, which refers to their ability to cause disease.
The susceptibility of the individual to the pathogens.
Concurrent physical or chemical stresses in the environment, which can enhance the effects of biological hazards.

Ergonomic Hazards

Ergonomic hazards refer to the stress and strain placed on the body through posture and movement, such as frequent repetitive handling of small boxes.

Ergonomics, also known as human engineering or human factors, focuses on designing machines, products, and systems to maximize the safety, comfort, and efficiency of the people who use them.

The ergonomics triad emphasizes that for work to be safe and efficient, the worker/human, the task, and the environment should be in harmony. By considering these three elements in combination, ergonomics aims to optimize the interaction between workers and their work settings, which can lead to increased productivity, reduced risk of injuries, and enhanced well-being for employees.

Principles of Ergonomics

There are 10 fundamental principles of ergonomics which are:

1. Work in neutral postures

Proper posture maintenance is necessary
Working too long with “C” curve can cause strain
Keeping the proper alignment of neck hands wrist are also necessary

2. Reduce excessive force

Excessive pressure or force at the joints can cause injury
Better to minimize the work that requires more physical labor

3. Keep everything in reach

Keeping everything in reach would help in avoiding unneeded stretching and strain
More or less this principle is related to maintaining good posture.

4. Work at proper height

Working at right makes things way easier
Sometimes height can be maintained by adding extensions or avoiding extensions on the chair or tables

5. Reduce excessive motions

Repetitive motion needs to be avoided
This can cause disorder and numbness in long run
Motion scan be reduced by the use of power tools

6. Minimize fatigue and static load

Fatigue is common in strenuous work
Having to hold things for longer period is example of static load
Fatigue can be reduced by the intervals and the breaks between the works.

7. Minimize pressure points

One needs to be aware of pressure points
Almost everyone has to sit on chairs that have cushioning, one of the pressure points is behind the knees, which happens if air is too high or when you dangle your legs. Pressure point is also created in between your thigh and the bottom of a table when you sit.
Anti-fatigue mats or insole can be used

8. Provide clearance

Work area should have enough clearance
Let the worker not worry about the bumps that they have to encounter on a daily basis.

9. Move, exercise and stretch

Move and stretch when you can
It better to take intervals between the works and stretch and move along
Stretching technique may differ and depend on the work one does

10. Maintain a comfortable environment

This principle is focused on the other components of the working environment.
It is concerned about lightning, space, cool air and many more.

Causes of Ergonomic Hazards

Many ergonomic problems arise from technological changes or poorly designed job tasks. The following conditions can contribute to ergonomic hazards:

Repetitive Motions: Performing the same motion repeatedly, like typing or using a mouse, can strain muscles, tendons, and nerves.
Awkward Postures: Maintaining uncomfortable positions for extended periods, such as reaching overhead or bending at the waist, can cause muscle imbalances and pain.
Forceful Exertion: Applying excessive force, such as lifting heavy objects or using tools with high resistance, can lead to injuries like muscle strains and tendonitis.
Static Posture: Holding the same position for long periods, like sitting at a desk or standing in one spot, can restrict blood flow and cause discomfort and pain.
Vibration: Exposure to excessive vibration, like from using power tools or operating machinery, can damage nerves, tendons, and bones.
Improper Workstation Design: Workstations that are not properly designed to fit the individual worker’s needs can contribute to many ergonomic hazards. This includes factors like desk height, chair adjustments, and monitor placement.
Poor Lighting: Inadequate or improper lighting can strain the eyes and lead to headaches and fatigue.
Insufficient Work Breaks: Lack of adequate rest breaks allows fatigue to build up, increasing the risk of injury.
Heavy Lifting: Lifting heavy objects improperly or frequently can put strain on the back, shoulders, and knees.
Lack of Training: Employees who are not properly trained on how to perform their tasks safely and ergonomically are more likely to be exposed to hazards.

Repetitive motions or shocks over prolonged periods, such as those involved in jobs like sorting, assembling, and data entry, can lead to irritation and inflammation of the tendon sheath in the hands and arms, known as carpal tunnel syndrome.

Effects of Ergonomic Hazards

Tenosynovitis: This condition affects the tendons and the sheaths that surround them. Repetitive motions, especially those involving the wrist and hand, can cause inflammation and pain within the tendon sheath. This can lead to stiffness, swelling, and difficulty moving the affected area.
Bursitis: This involves inflammation of the bursa, a fluid-filled sac that cushions and lubricates joints. Ergonomic hazards like repetitive motions, awkward postures, and forceful exertion can irritate the bursa, causing pain, swelling, and tenderness.
Carpal Tunnel Syndrome: This condition occurs when the median nerve, which runs through the carpal tunnel in the wrist, is compressed. Repetitive hand movements, awkward postures, and prolonged pressure on the wrist can all contribute to this nerve compression, leading to numbness, tingling, and weakness in the hand and fingers.
Raynaud’s Syndrome (“White Fingers”): This condition affects blood circulation in the fingers, causing them to turn white, then blue, and finally red. Exposure to cold temperatures and vibrations can trigger Raynaud’s syndrome, often seen in workers who operate vibrating tools or work in cold environments.
Back Injuries: Ergonomic hazards like poor posture, heavy lifting, and repetitive bending can strain the muscles, ligaments, and discs in the back. This can lead to pain, stiffness, and even herniated discs.
Muscle Strain: Overusing muscles or straining them through awkward postures can lead to muscle strain, resulting in pain, tenderness, and limited range of motion. This is common in workers who perform repetitive tasks or lift heavy objects improperly.

Prevention of Ergonomic Hazards

To prevent ergonomic hazards, the following control measures should be implemented:

1. Ergonomic Design & Engineering:

Workstation Optimization: Design workstations with adjustable heights, comfortable seating, and proper monitor placement to promote neutral postures and minimize strain.
Equipment Selection: Choose tools, equipment, and furniture that are ergonomically designed to reduce strain and fatigue. This includes computer workstations, chairs, and lifting devices.
User Input: Involve workers in the selection and testing of new equipment to ensure it meets their needs and reduces ergonomic risks.

2. Work Practices & Training:

Proper Lifting Techniques: Provide training on safe lifting techniques to minimize back strain and injuries. Encourage the use of lifting aids for heavy objects.
Task Rotation: Rotate workers among different tasks to avoid prolonged exposure to repetitive motions or static postures.
Work Breaks & Rest: Encourage frequent breaks to stretch and move around, reducing muscle fatigue and stiffness.
Ergonomics Education: Train workers to recognize biomechanical risk factors, understand the signs and symptoms of ergonomic injuries, and implement safe work practices.

3. Administrative Controls:

Work Shift Scheduling: Optimize work schedules to minimize extended work hours and overtime, reducing the risk of fatigue-related injuries.
Workload Management: Ensure workloads are manageable and avoid excessive demands that could lead to ergonomic hazards.
Job Design: Evaluate tasks and consider alternative methods to minimize repetitive motions, awkward postures, and forceful exertions.

4. Personal Protective Equipment:

When Necessary: Provide and mandate the use of personal protective equipment (PPE) when it can help prevent injuries, such as gloves for tasks involving vibrations or hand tools.

5. Continuous Improvement & Monitoring:

Self-Assessments: Provide workers with self-assessment tools to identify potential ergonomic hazards in their work areas.
Regular Reviews: Conduct periodic ergonomic assessments of workplaces, work processes, and equipment to identify areas for improvement.
Incident Reporting: Encourage workers to report any incidents or discomfort related to ergonomic hazards. This data can be used to make adjustments and improve safety.

Ergonomics, or the proper design of work systems based on human factors, offers several advantages, including more efficient operations, fewer accidents, reduced training time, lower operational costs, and more effective use of personnel.

Psychosocial Hazards

Psychosocial hazards are factors in the workplace that can cause psychological stress and strain on individuals.

These hazards have become more prevalent in recent years, with issues such as time pressure, hectic work environments, and the risk of unemployment contributing to psychological stress. Jobs with heavy responsibility, monotonous work, and constant concentration requirements can also have adverse psychological effects.

Types of Psychosocial Hazards

Poor vocational guidance: Lack of clear career paths, training opportunities, or support for professional development can lead to frustration and demotivation.
Poor arrangement of working hours: Inconsistent or unpredictable schedules can disrupt sleep patterns and contribute to work-life imbalances.
Poor job design and work methods: Repetitive, monotonous tasks, lack of autonomy, and unclear job responsibilities can contribute to burnout and dissatisfaction.
Poor management: Lack of support, unclear expectations, ineffective communication, and inconsistent leadership styles can create a stressful and toxic work environment.
Abusive patients: Exposure to aggressive or abusive patients can lead to emotional distress and stress for healthcare workers.
Long working hours: Excessive work hours without adequate breaks can lead to fatigue, stress, and burnout
Sexual harassment: Unwanted sexual advances, requests for sexual favors, or other verbal or physical harassment based on sex can create a hostile work environment.
Workplace violence: Threats, harassment, or physical violence in the workplace can create a climate of fear and anxiety.
Unfriendly work shifts: Such as chronic night duties can lead to stress.
Technostress: The constant pressure to keep up with new technologies, manage a growing volume of information, and remain connected can lead to stress and burnout
Substance abuse as a response to excessive workplace stressors
Work-Life Conflict: Balancing work demands with family responsibilities and personal commitments can lead to stress and anxiety.
Exposure to Stressors: Noise, poor air quality, and other environmental factors can contribute to stress and affect mental well-being.
Exposure to poor indoor air quality that induces stress

Control Strategies for Psychosocial Hazards Work Shift Issues

Engage workers in the design and planning of shift schedules.
Avoid scheduling demanding, dangerous, or monotonous tasks during the night shift, especially during early morning hours when alertness is lowest.
Limit permanent night shifts and offer a choice between permanent and rotating shifts.
Use forward-rotating schedules for rotating shifts when possible.
Arrange shift start/end times to correspond to public transportation or provide transport for workers on specific shifts.
Limit shifts to a maximum of 12 hours (including overtime) and consider the needs of vulnerable workers.
Limit night shifts to 8 hours for demanding, dangerous, or monotonous work.
Encourage regular breaks away from the workstation and discourage saving up break time for the end of the workday.
Limit consecutive working days to a maximum of 5-7 days.
Limit consecutive shifts to 2-3 days for long work shifts, night shifts, and shifts with early morning starts.
Design shift schedules to ensure adequate rest time between successive shifts.
Provide a minimum of 2 nights’ full sleep when switching from day to night shifts.
Incorporate regular free weekends into the shift schedule.

Technostress (Stress Resulting from New Technologies)

Select user-friendly technology.
Involve workers in technology selection, trial, and implementation, and gather feedback on its use.
Provide sufficient training to ensure workers feel confident and competent in using the technology.

Work-Life Balance and Reduction of Excessive Workloads

Offer flexible time arrangements, such as alternative work schedules, compressed work weeks, reduced hours/part-time work, and phased retirement.
Allow flexible work locations through telecommuting and satellite offices.
Implement flexible job design through job redesign and job sharing.
Provide wellness programs.
Offer flexible benefits including paid and unpaid leaves for maternity, parental care, education, and sabbatical.
Support employer-sponsored childcare and eldercare services.

Workplace Violence

Establish management policies and procedures with a zero-tolerance approach to violence or abuse.
Provide worker education on violence awareness, avoidance, and de-escalation procedures.
Establish liaison and response protocols with local police.
Enable workers to request support.
Offer counseling services.

Work-Related Stress

Provide training to increase awareness of signs and symptoms of critical incident stress.
Establish a critical incident stress team to respond to incidents, with clear communication and call procedures.

Work-Related Substance Abuse

Provide problem-solving resources and support for workers.
Involve workers in the development of substance abuse policies and procedures.
Educate workers about substance abuse.
Implement procedures to limit individual access to narcotics.
Offer counseling services and return-to-work plans.

Conditions Likely to Be Sources of Workplace Hazards

Ensure proper access routes, such as ramps.
Address hazardous tasks in the workplace, such as repetitive lifting of patients.
Ensure correct installation and use of equipment/machines.
Maintain and repair equipment adequately.
Address exposure to hazardous substances, such as blood and other body fluids.

The Epidemiologic Triangle

The Epidemiologic Triangle is a model that helps us understand infectious diseases. It has three parts:

Agent: The microbe that causes the disease.
Host: The organism that is infected with the disease.
Environment: The surroundings that allow the disease to spread.

Agent

The agent is the cause of the disease. When studying the epidemiology of most infectious diseases, the agent is a microbe—an organism too small to be seen with the naked eye. Disease-causing microbes are bacteria, viruses, fungi, and protozoa (a type of parasite).

Bacteria: Single-celled organisms that can reproduce themselves.
Viruses: Tiny particles that contain genetic material but cannot reproduce on their own.
Fungi: Multicellular organisms that live off other organisms.
Protozoa: Single-celled organisms that live off other organisms.

Host

The host is the organism that is infected with the disease. The host can be a human, animal, or insect. The host’s immune system plays a role in determining whether or not the disease will develop.

Environment

The environment includes the physical surroundings, such as temperature and humidity, as well as the presence of other organisms. The environment can also play a role in the spread of disease. For example, mosquitoes can transmit malaria, and contaminated water can transmit cholera.

Conclusion

The Epidemiologic Triangle is a useful tool for understanding how infectious diseases spread. By understanding the three parts of the triangle, we can better prevent the spread of disease.

Here are some additional points to consider:

The Epidemiologic Triangle can be used to understand a variety of infectious diseases.
The three parts of the triangle are interconnected.
By breaking one of the links in the triangle, we can help to prevent the spread of disease.

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Occupational Health and Safety

OCCUPATIONAL HEALTH AND SAFETY

Occupational health is an area of work in public health to promote and maintain the highest degree of physical, mental and social well-being of workers in all occupations. According to WHO

Occupational health is also defined as the overall well-being—physically, mentally, and socially—of individuals in relation to their work and working environment.

Occupational Health and Safety: This discipline is dedicated to preventing workers from contracting diseases or sustaining injuries as a result of their work. According to the World Health Organization (WHO, 1995), occupational safety and health encompass the following multidisciplinary activities:

Protection and promotion of workers’ health by eliminating hazardous occupational factors and conditions that pose risks to their well-being and safety at work.
Enhancement of workers’ physical, mental, and social well-being, supporting the development and maintenance of their working capacity, as well as their professional and social growth within their work environment.
Development and promotion of sustainable work environments and organizations.

Occupational health is also defined as the overall well-being—physically, mentally, and socially—of individuals in relation to their work and working environment.

It involves both the individual’s adjustment to work and the adaptation of work to the individual (Forsman, 1976). The WHO defines occupational health as the “promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations.” Furthermore, the WHO considers occupational health services responsible for the well-being of workers and, whenever possible, their families as well.

Definition of Terms

Occupational Epidemiology: This field focuses on studying the occurrence of diseases in relation to work-related factors.
Occupational Biostatistics: It serves as a vital tool for quantitatively studying morbidity and mortality in humans, particularly in relation to workplace exposure.
Ergonomics: This discipline involves tailoring the job to fit the workers, encompassing the design of machines, tools, equipment, work layouts, methods, and environments. Its objective is to enhance human efficiency and well-being, thereby reducing industrial accidents and improving overall worker health and productivity.
Risk Assessment: The process of identifying and evaluating potential risks and hazards in the workplace to determine appropriate preventive measures. Example: Conducting a risk assessment to identify potential hazards associated with a chemical substance used in a laboratory.
Hazard Control: Implementing measures to eliminate or minimize workplace hazards and reduce the risk of accidents or injuries. Example: Installing safety guards on machinery to prevent workers from coming into contact with moving parts.
Personal Protective Equipment (PPE): Equipment worn by workers to protect themselves from potential workplace hazards. Example: Safety goggles, gloves, and helmets used to protect workers from eye injuries, hand injuries, or head injuries.
Safety Training: Providing education and training to workers on occupational health and safety practices, procedures, and emergency protocols. Example: Conducting regular safety training sessions to ensure workers are aware of fire evacuation procedures and know how to respond in an emergency.
Incident Investigation: The process of examining workplace incidents, accidents, or near-miss events to identify their causes and implement corrective measures to prevent future occurrences. Example: Investigating a workplace fall to determine whether it was caused by inadequate safety measures or improper equipment usage.
Workplace Ergonomics: Designing and arranging workspaces, equipment, and tasks to fit the capabilities and limitations of the workers, promoting comfort, safety, and efficiency. Example: Adjusting the height and position of computer monitors to reduce neck strain and prevent musculoskeletal disorders.
Safety Culture: The shared values, beliefs, attitudes, and behaviors regarding workplace safety within an organization. Example: Encouraging open communication about safety concerns, recognizing and rewarding safe practices, and fostering a proactive approach to safety among employees.

Aims/Objectives of Occupational Safety and Health

Promoting and maintaining the highest level of physical, mental, and social well-being for workers in all occupations. Example: Ensuring that workers have a safe and healthy work environment that contributes to their overall well-being.
Preventing workers from being affected by harmful working conditions that can negatively impact their health. Example: Implementing measures to protect workers from exposure to hazardous substances or dangerous equipment.
Protecting workers from work-related risks and hazards that may arise in their employment. Example: Establishing safety protocols and providing personal protective equipment (PPE) to minimize workplace accidents and injuries.
Creating and maintaining an occupational environment that is tailored to meet workers’ physiological and psychological needs. Example: Adapting workstations to ergonomic standards to prevent musculoskeletal disorders and promote comfort.
Ensuring that work is adjusted to suit individuals and that individuals are well-suited for their jobs. Example: Assigning tasks that match workers’ skills and capabilities, allowing them to perform their duties effectively and safely.

Alice’s First Day at Nurses Revision Hospital

Alice was happy to start her new job as a nurse at Nurses Revision Hospital. She was healthy and excited about her new role.

Promoting and Maintaining Well-Being: When Alice arrived, she noticed the hospital had a welcoming environment. The management prioritized the well-being of all employees. They ensured everyone had regular health check-ups, access to mental health resources, and social activities to foster a supportive community.

Preventing Harmful Conditions: On her first day, Alice attended a training session where she learned about the importance of preventing harmful working conditions. The hospital had strict protocols to protect staff from exposure to hazardous substances, such as proper handling of chemicals and safe disposal of medical waste.

Protecting from Risks and Hazards: Alice was provided with personal protective equipment (PPE), including gloves, masks, and gowns, to protect her from potential risks and hazards. The hospital also had safety protocols in place, like emergency evacuation plans and regular fire drills, to ensure everyone knew how to respond in case of an incident.

Creating an Enabling Environment: Alice’s workstation was ergonomically designed. She had a comfortable chair, a properly adjusted computer screen, and a supportive mat to stand on. This setup helped prevent musculoskeletal disorders and promoted her comfort while working long shifts.

Adjusting Work to Suit Individuals: The hospital management made sure that Alice’s tasks matched her skills and capabilities. They provided continuous training to help her develop her skills and assigned her tasks she was confident in handling. This approach ensured that Alice could perform her duties effectively and safely.

Principles of Occupational Health and Safety

Protecting and promoting workers’ health by preventing and controlling occupational diseases and accidents and eliminating hazardous factors and conditions at work. Example: Implementing safety protocols and providing training to prevent accidents, as well as monitoring and addressing any potential occupational health hazards.
Developing and promoting healthy and safe work environments and organizations by adapting working conditions to meet the needs of workers. Example: Modifying workplace layouts or processes to reduce physical strain and improve worker well-being.
Enhancing workers’ physical, mental, and social well-being, supporting their professional and social development, and maintaining their capacity to work. Example: Offering health and wellness programs, promoting work-life balance, and providing opportunities for skill development and career growth.
Enabling workers to lead productive lives and contribute to sustainable development. Example: Supporting initiatives that foster a healthy work-life balance, job satisfaction, and employee engagement, which ultimately benefits both individuals and the organization.
Providing curative and rehabilitative services to address any health issues or injuries that may occur in the workplace. Example: Offering medical treatment, rehabilitation programs, and support for workers who experience work-related injuries or illnesses.
Ensuring immediate response through first aid and emergency measures for victims. Example: Establishing protocols for first aid training and having emergency response systems in place to provide prompt medical assistance when accidents occur.

Components of Occupational Health and Safety in the Workplace

Availability of Regulations: Have occupational health and safety regulations within the workplace to ensure compliance and worker safety.
Safety Committee: Establishing an active and effective occupational health and safety committee to address and manage safety concerns and initiatives.
Hazard Control: Monitoring and managing workplace hazards to prevent potential health risks for employees.
Hygiene Maintenance: Overseeing cleanliness and sanitation facilities to maintain worker health and well-being.
Protective Device Standards: Regularly inspecting the health and safety standards of protective devices used in the workplace to ensure they meet requirements.
Health Examinations: Conducting various health assessments, including pre-employment, periodic, and special health examinations for workers.
Ergonomics: Tailoring work conditions to accommodate individual needs and enhance worker well-being.
First Aid Services: Providing access to first aid services to address injuries and illnesses promptly.
Training and Education: Offering health education and safety training to workers to increase awareness and knowledge.
Incident Reporting: Reporting incidents such as occupational deaths, diseases, injuries, disabilities, hazards, and their prevention measures to enhance workplace safety and prevent future occurrences.

Elements of the work

The worker: The individual who performs the work or job e.g. a health worker
The tool: The machine the person doing a job uses e.g. injection syringe
The process: The steps the person who does a job takes to do the job e.g. steps of administering an IM injection.
The work environment: The place or situation in which a person who does the work lives in e.g. hospital, health care place.

The elements of work encompass the worker, the tool they utilize, the process they follow to perform the job, and the work environment they operate within. For example, a health worker (the worker) administers an intramuscular injection using an injection syringe (the tool) by following a specific set of steps (the process), typically in a hospital or healthcare facility (the work environment).

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Ethics in Research

Research Ethics

Ethics refers to the discipline of distinguishing between what is good and bad, involving moral duty and obligation.

It encompasses a set of moral principles or values that guide behavior and conduct.
Ethics establishes the principle of conduct governing individuals or groups.
In research, ethics provides guidelines for the responsible conduct of biomedical research. It ensures that research is conducted in an ethical manner, with a focus on protecting the welfare and rights of research participants. In addition, research ethics educates and monitors scientists conducting research to ensure a high ethical standard.

History of Research ethics

The development of modern research ethics began from the need to protect human subjects involved in research projects.
The first significant attempt to establish regulations occurred during the Doctors Trial of 1946-1947 in Germany, which took place after World War II.
The Doctors Trial was part of the Nuremberg Trials for Nazi war criminals, where the accused violated basic ethical principles.
The Nuremberg Code emerged from this trial and comprised ten ethical guidelines that emphasized the importance of voluntary consent, societal benefits, scientific basis, avoidance of unnecessary suffering, and the prohibition of research with potential harm or death as outcomes.
The Nuremberg Guidelines laid the foundation for subsequent initiatives, such as the Helsinki Declaration, which aimed to promote responsible research with human subjects.
Another significant document is The Belmont Report, published in 1978 by the U.S. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, which further defined ethical principles in research.

The Nuremberg Code consisted of ten basic ethical principles that the accused violated.

The 10 guidelines were as follows

Research participants must voluntarily consent to research participation
Research aims should contribute to the good of society
Research must be based on sound theory and prior animal testing
Research must avoid unnecessary physical and mental suffering
No research projects can go forward where serious injury and/or death are potential outcomes
The degree of risk taken with research participants cannot exceed anticipated benefits of results
Proper environment and protection for participants is necessary
Experiments can be conducted only by scientifically qualified persons
Human subjects must be allowed to discontinue their participation at any time
Scientists must be prepared to terminate the experiment if there is cause to believe that continuation will be harmful or result in injury or death.

Why study research ethics

Studying research ethics is a reflection of respect for individuals who participate in research studies.
It ensures that researchers do not make unreasonable, unsafe, or thoughtless demands on participants.
Research ethics ensures the sharing of sufficient knowledge among all concerned parties.
It establishes a common standard for ethical conduct, which has become the norm and an expectation in research activities.
Research ethics is a professional requirement in disciplines like nursing.
It is also necessary for accessing participants in health-related research.

Major concerns in research ethics

PLAGIARISM

Plagiarism is the act of passing off somebody else’s ideas, thoughts, pictures, theories, words, or stories as your own.

If a researcher plagiarizes the work of others, they are bringing into question the integrity, ethics, and trustworthiness of their research.

Forms of plagiarism

Intentionally taking a passage word-for-word without proper credit
Unintentionally (or simply lazy) paraphrased and fragmented texts the author has pieced together from several works without properly citing the original sources
NOTE: No form of plagiarism is tolerated by the scientific community, including unintentional plagiarism.

How to handle plagiarism:

- Cite all ideas and information that are not your own and / or is not common knowledge.
- Use quotation marks when using someone else’s words.
- Clearly indicate the origin of paraphrased sections and provide proper citations.
- At the beginning of a paraphrased section, show that what comes next is someone else’s original idea (example: these bullet points start out by saying the information originated ……….),
- At the end of a paraphrased section, place the proper citation

AUTHORSHIP

Authorship is the process of deciding whose names belong on a research paper.

Research often involves collaboration and assistance between experts and colleagues.
Responsible authorship practices require acknowledging contributions and determining joint authorship when necessary, therefore responsible authorship practices are an important part of research.

How is authorship is achieved

Authorship credit should be based only on

1. substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data;
2. drafting the article or revising it critically for important intellectual content; and
3. final approval of the version to be published.
4. Conditions 1, 2, and 3 must all be met.
5. Acquisition of funding, data collection, or general supervision of the group alone does not justify authorship.

“Can I be a co-author?”

“Sure! But only if you…

Contribute substantially to the research, AND…
Write or revise all or part of the manuscript, AND…
Approve the final version of the entire article.”

Co-authorship requires substantial contribution to the research, writing or revising the manuscript, and approval of the final version.

RESEARCH MISCONDUCT

Research misconduct is the process of identifying and reporting unethical or unsound research.

Research misconduct is defined as fabrication, falsification, or plagiarism in proposing, performing, or reviewing research, or in reporting research results.

Fabrication is making up or recording false data or results.
Falsification is manipulating research materials, equipment, processes, or omitting data to misrepresent the research.
Plagiarism is appropriating another person’s ideas, processes, results, or words without giving appropriate credit.

Research misconduct does not include honest error or differences of opinion.

General ethical principles

Research with human subjects involves various ethical considerations relevant to nursing practice. Understanding and applying the following principles is crucial for conducting ethical research in Uganda:

Respect for Persons
- Individuals have the right to make autonomous decisions, and their choices should be respected.
- People who cannot make autonomous decisions should receive appropriate protection.
- Voluntary subjects should receive adequate information for decision-making.
- Example: In a study on informed consent for pediatric patients, nurses must ensure that parents or guardians understand the research purpose, potential risks, benefits, and their right to withdraw their child from participation.
Informed Consent
- Informed consent ensures that research participants have a clear understanding of the research and voluntarily agree to participate.
- Information provided to participants should be comprehensive, understandable, and adapted to their abilities and language needs.
- Participants should not be coerced or manipulated into participating.
- Example: Before conducting a study on elderly patients’ experiences with pain management, nurses must explain the study purpose, procedures, potential benefits, and risks to the participants, allowing them to make an informed decision to participate or not.
- Requirements for Informed Consent
- 1. When obtaining informed consent from research participants, the information disclosed should include:
  1. Research procedure,
  2. Purpose of the research,
  3. Risks and anticipated benefits associated with participation,
  4. Alternative procedures (especially in therapeutic research),
  5. A statement providing the opportunity for participants to ask questions and withdraw from the research at any time.
  2. Comprehension: To ensure comprehension, researchers must adapt the information to be understandable for every participant. This requires considering factors such as:
  1. Different abilities,
  2. Intelligence levels,
  3. Maturity,
  4. Language needs.
  3. Voluntariness: , informed consent must be voluntary and free from coercion or improper pressure. Participants should have the freedom to make their own decision regarding participation.
Privacy and Confidentiality
- Privacy and confidentiality are vital in research to protect participants’ sensitive information.
- Participants have the right to control and keep private information about themselves.
- Researchers must ensure that data collected during research participation are anonymized and stored securely.
- Example: In a study on mental health stigma, nurses must guarantee that participants’ identities and personal information are kept confidential to protect their privacy and prevent potential harm.
Beneficence
- Beneficence is a principle used frequently in research ethics. It means, “doing good”
- Beneficence means maximizing potential benefits and minimizing potential harm to research participants.
- Researchers should strive to conduct studies that offer a favorable balance of potential benefits and risks.
- Participants should not be subjected to unnecessary risks or harm beyond what is necessary for the research.
- Be prepared to cease research if it is causing harm, and never put participants at a level of risk disproportionate to the anticipated benefits.
- Example: When conducting a study on the effectiveness of a new nursing intervention for wound care, nurses should ensure that the potential benefits outweigh any potential discomfort or inconvenience experienced by the participants.
Justice
- This principle means treating people with “fairness”
- This principle aims at preventing the overburdening of some populations in order to apply research findings to other groups.
- Researchers should avoid overburdening vulnerable populations and ensure equitable access to research opportunities.
- Examples of vulnerable populations in nursing research may include marginalized communities, children, pregnant women, or individuals with mental health conditions.
- Example: When conducting a study on healthcare access in rural areas, nurses should ensure that participants from underserved communities have an equal opportunity to participate and benefit from the research findings.
- Another Example: let’s consider a research study on the effectiveness of a new medication for managing a chronic disease. To uphold the principle of fairness, the study should aim to include a diverse population that represents various demographic groups. This ensures that the research findings can be applied to a wide range of individuals who may benefit from the medication, without excluding or disproportionately burdening any specific group.
  Like a drug should be tested on pregnant mothers, elderly, so that when it is out, both groups can benefit from it, not carrying out research on only the elderly and yet even pregnant mothers would benefit from it.

The Institutional Review Board (IRB)

These are bodies mandated by state, institutions and organizations to review research proposals in which there are human participants to ensure ethical research. Also called Research and Ethics committees(REC). In Uganda, researchers, including nursing students, should engage with the Research and Ethics committees(REC) to ensure ethical research practices, and prominent institutions in Uganda have Institutional based Research Ethics Committees e.g. The Uganda Christian University REC(UCU-REC), Mengo Hospital-REC, e.t.c.

The IRB is a mandated body that reviews research proposals involving human participants to ensure ethical standards are met.
The roles of the IRB include balancing potential risks and benefits,
protecting participants from unnecessary harm,
offering proportional compensation, and
ensuring the research is conducted by qualified scientists.
The IRB also ensures that informed consent and other research-related documents are readable, understandable, and promote voluntary participation.
Example: As nursing students, when planning a research study involving human participants, it is important to submit the research proposal to the IRB for review and obtain ethical clearance before commencing the study. This ensures that the study adheres to ethical principles and safeguards the welfare of the participants.

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Gender Based Violence (GBV)

Gender based violence is any act that results in physical, sexual or psychological harm or suffering to women, men and children

Key terms related to Gender-based Violence

Gender;

This refers to the social and cultural construct of the roles, responsibilities, characteristics, opportunities, privileges, status and access to and control over resources and benefits between men and women, boys and girls in a given society.

Men and female are sex categories while masculine feminine are gender Aspect of sex will not vary substantially between different human societies while aspect of gender will vary greatly.

Example of gender characteristics

In developed countries women earn significantly less money than men for similar work.
In many society, many more men smoke tobacco than women as female smoking has not traditionally been considered appropriate.
In some countries, men are allowed to drive while women don’t.

2. Gender-based violence;

This is any act that results in physical, sexual or psychological harm or suffering to women, men and children. It also includes threats of such acts; coercion and deprivations of liberty whether occurring in public or in private life.

3. Violence against women;

Refers to any act of gender-based violence that results in or is likely in physical, sexual and psychological harm to women and girls whether occurring in private or in public. Violence against women is a form of gender-based violence and includes sexual violence.

4. Sexual violence, exploitation and abuse.

This refers to any act, attempt or threat of sexual nature.

5. Gender equality

This is the state or condition that awards men and women equal engagement of human rights, socially valued goods, opportunities and resources.

6. Gender blind

Refers to a policy or plan that is silent on relevant gender issues

7. Gender responsiveness

This is a policy or plan with actionable strategy that seeks to reduce inequality and ensures equal distribution of the benefits associated with a particular service.

8. Sexual and gender-based violence is a serious form of discrimination, particularly against women and children and as such contravenes the principle of no It is both a public health problem and a human right issue.

9. Sex

It’s defined as biological characteristics of male and females. The characteristics are congenital and their differences are limited to physiological reproductive functions.

10. Violence

This is any act that causes injury, harm, intimidation, fear, damage or humiliation to s person. It is a mean of control and oppression that can include emotional, social and economic force or pressure as physical harms. Examples like; threatening someone with a weapon, intimidation, physical assaults etc. The person targeted by this kind of violence is to behave as expected or act against his/her will out of fear.

11. Sex typing

This refers to the differential treatment for people according to their biological sex.

12. Gender equity

This is when women and men, boys and girls have equal opportunities of receiving services which are equally accessible to all.

13. Gender sensitive

This refers to being aware that women and men perform different roles and have different needs which must be planed for accordingly.

14. Gender neutrality

This refers to planning for men and women as if they are homogenous i.e. without taking consideration of their different needs and roles. Such programs are usually not effective because they fail to response to gender specific needs of individual. Treatment care and services do not favor women and men e.g. women to be examined by male and vice versa.

15. Gender roles

These are the different task and responsibilities that society, defines and allocates to women and men, girls and boys. They are not necessarily determined by their biological make up and therefore change according to situation, time and society.

16. Coercion;

This is forcing or attempting to force another person to engage in behavior against this/her will by using threats, verbal insistence, manipulation, deception, cultural expectations or economic power.

17. Sexual preference/orientation

This refers to a person’s preference for the same or opposite partner e.g. homosexual, heterosexual.

18. Gender role stereotype

This is socially determining model which contain the cultural beliefs about what gender role should be.

Examples

– Girls should be obedience and cute, and allow to cry while boys are expected to be brave. However, women are better house keeper and boys strong, good at machinery similarly, boys are better at mathematics and girls are good at language differs from gender role in that it tends to be the way people fill adult others should behave.

Forms of violence in Uganda

Domestic violence such as wife battering, oppression, intimidation
Sexual abuse g. Rape, defilement and incest.
Harmful cultural practices like female genital mutilation and widow
Forced marriages: Girl children are married off early for economic purposes in form of bride Others are married off early because the girl child culturally is destined for marriage instead of advancing in education.
Others;
- Sexual harassment and intimidation at work places, religious institutions and schools
- Coercion or arbitrary deprivation of
- Belief in large families
- Men having forced sex with
- Violence perpetrated or condoned by the

Setting where Gender-based violence can occur

Family; i.e. battering of women, sexual abuse of children and incest
Community; sexual abuse, sexual harassment and intimidation, trafficking and forced prostitution
State; poorly drafted or unenforceable laws, presence of law enforcement agents who violate people, lack of facilities and education for prevention and treatment of people exposed to violence.

Predisposing factors of sexual and gender violence

Low socio- economic status (topical) in the Women‘s low status in the community and their dependence on men to make decisions increase inequality and vulnerability to violence.
Infertility leading to the husbands and relatives blaming, battering or abandoning wife for this inability.
Fear of reporting because the perpetuators are not reprimanded and can easily come back to revenge.
Cultural definitions of gender roles e.g. Girls are made to fetch water, fire wood, cultivate and cook for the family. It is through execution of these duties that they meet men who defile them or boys grow up not knowing that they can help in performing some of the activities like cooking, washing utensils, clothes etc.
Some cultural practices like female genital mutilation, promoting early marriages of the girl child so as to earn bride pride for financial gains.
Physical and mental disabilities leading to rejection, discrimination and stigmatization. For instance people with blindness, deafness,
Ill health especially from HIV/AIDS.
Poverty making parents to force their daughters to be defiled or married so as to get some money as compensation.
Idleness and redundancy leading to over consumption of alcohol, drug abuse e.t.c.
Abduction of children exposing them to rape, defilement and assaults.
Land wrangles especially after a loss of a husband; the wife is denied ownership of property.
Conflict and camp environment resulting in congestion and loss of good morals.
Poor role modeling for boys and girls

Risk groups for Sexual Gender-based Violence

All children and women
Adolescents
Displaced persons including refugees
People with disabilities
Prisoners
Men in particular as they fear reporting acts of violence because they fear being embarrassed.
Pregnant mothers

Reasons for staying in an abusive relationship

Hope for change
Total love to the partner
Fear of losing the marriage
Purpose of the children
Shame
Poverty- fear of returning the bride price
Security purpose

Characteristics of those who are abused

They believe that violence give them immediate result
They are insecure, extremely jealous and possessive
They are emotionally dependent on other partner
They deny that their action are violence
They have poor impulse control

Impacts of Sexual Gender-based Violence

These may be physical and or psychological

Various forms of injury, physical, mental and psychosocial to the body of the victim/survivor.
Reduced quality of life and low self esteem
Sexually transmitted infections including HIV/AIDS
Unwanted pregnancies resulting into unsafe abortion which can result in the lifelong health effects and death/suicide
Poverty and loss of means of livelihood
School dropout and unknown paternity of children
Psychological and behavioral problems in children
Rejection of survivors by society/stigmatization
Divorce
Child neglect
Loss of friends
Spiritual shame
Prostitution
Alcoholism
Early marriage
Suicidal attempt and ideation

8Ways through which Sexual Gender-based Violence can be reduced in Uganda

Sexual and gender-based violence should be recognized as an important public health matter. Therefore, everyone in the community can contribute tremendously to reducing the acts of sexual gender-based violence by actively doing the following:

Leaders should spearhead sensitization of communities on the impacts of sexual gender-based violence throughout the country.
Reporting all acts of violence to the health centers, police, and other relevant authorities.
Ensuring that those who commit these acts are punished appropriately.
Some of the current measures to punish the perpetrators should be revised and made stronger to deter people from committing acts of violence.
Communities should be encouraged to stop the culture of silence which hampers victims from reporting fearing the repercussions e.g. imprisonment and stigmatization.
Advocacy to reduce sexual and gender-based violence must be intensified at all levels.
Review the legal systems to improve the court relationship between the legal officers and the victims.
Improve the relationship between the legal and other practitioners during court session.
Health workers should be supported to undertake their roles to manage and care for survivors of Sexual Gender-based Violence.

Roles of leaders on SGBV in their community

The following ways can be used by leaders to fight Sexual Gender-based Violence by:

Speaking out against Sexual Gender-based Violence at every opportunity for instance during community meetings, campaigns, fundraising, funerals, drinking places.
Leaders should strive to act as role models by avoiding being perpetrators of SGBV.
Assisting victims to get help and to see that the culprits such as defilers, rapists, men who batter their wives are reported to the police and punished appropriately.
Leaders can form counseling groups to help men, children and women who are perpetrators of Sexual Gender-based Violence.

Control and prevention of Sexual Gender-based Violence

Improve girl child education at all level.
Reducing the high level of poor socio-economic status will in long run reduce women vulnerability to violence.
Increasing awareness of women‘s rights and responsibilities related to owning property and assets.
Reviewing and amending laws that safeguard women‘s rights.
Strengthening nationwide/community wide efforts to challenge the widespread tolerance and acceptance of violence against women.
Encouraging parents to bring up children who respect the rights of individuals as men or women, boys or girls
Supporting parents to bring up their boys and girls as equal partners

Reasons why the community and leaders be concerned about SGBV

Damages social bonds if women and girl who are sexually abused isolate themselves or are isolated by their families and communities.
Places a substantial health burden on the health care Example, victims often present with vague complaints that are difficult to diagnose and to treat.
Brings economic loss to households and communities when victims of Sexual Gender-based Violence due to physical injury or emotional stress are unable to undertake their roles in the households and the workplace (in many Uganda villages, women are among the key bread winners in their homes).
Bring a legacy of bitterness especially in conflict situation towards the group from which the perpetrators came. This will have a negative long term impacts on reconciliation and community reconstruction.

Roles of health workers in managing victims and addressing gender-based violence

This is important to note that health workers play instrumental roles in ensuring that families and victims of gender-based violence are professionally attended and see that the victims get justice. Therefore, the following cited are some of roles of health worker in gender-based violence management;

Offering psychosocial support and counseling services to the affected families and individuals.
Liaising with people and other stakeholders to see that the perpetrator (culprits) is brought to book to prevent possibility of reoccurrences.
Collecting victim‘s medical information and performing required medical examination to promote continuity of care.
Creating a friendly and confidential environment (shelter) where victims needs are addressed.
Offering timely and appropriate referral services as needed.
Establishing and promoting strict reporting of all gender-based violence related cases to responsible authority and ensure victims get fair justice.
Ensuring and maintaining constant follow-up care of all affected families or victims.

Sources of help for victims of SGBV

Police
Probation officers
Child and family protection unit.
Local leaders/elders
Trusted person or family members
Counselors etc

Note: In some African cultures, beating a woman or girls is part of the disciplining process; in fact some women even willingly accept to be beaten

Gender Based Violence (GBV) Read More »

Hormonal Methods of Family Planning

Hormonal family planning refers to the use of hormonal methods to prevent pregnancy. These methods involve the use of hormones, typically synthetic versions of those naturally produced by the body, to regulate a woman\’s menstrual cycle and prevent ovulation (the release of an egg from the ovaries). By preventing ovulation, hormonal methods make it difficult for sperm to fertilize an egg and thus prevent pregnancy.

These include;

Oral contraceptive pills
Implants
Injectable contraceptive
Emergency contraceptive pills

Oral Contraceptive Pills

i) Progesterone Only Pills (POP)

Examples

Ovrette
microval

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They contain progesterone hormone
They are recommended for breastfeeding mothers because they do not affect/suppress milk

Modes of action

It acts mainly by making cervical mucus thick and viscous, thereby preventing sperm penetration
Endometrium becomes atrophic so blastocyst implantation is also
In about 2% ovulation is inhibited and 50% of women ovulate normally

Advantages

Highly effective
Limited related side effects
Protects against unwanted pregnancy
Do not affect breastfeeding
May decrease menstrual cramps
May improve anemia
Protects against ectopic pregnancy

Contraindications

Pregnancy
Unexplained vaginal bleeding
Recent history of breast cancer
Arterial diseases
Thromboembolic diseases
Active hepatic diseases
Hypertension

Side effects

Amenorrhea
Spotting
Prolonged or heavy bleeding
Lower abdominal pain
Weight gain or lose
Jaundice
Nausea and vomiting
Headache with blurred vision
Excessive hair growth
Breast fullness or tenderness
High blood pressure

i) Combined Oral Contraceptive Pills (COC)

This contains both oestrogen and It achieves effects of both hormones
Oestrogen suppresses ovulation and progesterone creates unfavorable conditions for egg transport and thickening of the cervical mucus to impair sperm entrance into the canal.

Examples

Lo-femenal
Pillplan (duofen)
Microgynon

$\"\"$ $\"\"$ $\"\"$

Advantages

Highly effective (99%)
Protects against unwanted pregnancy
It is convenient, simple to take and does not interfere with sexual intercourse
Helps to correct menstrual irregularities
Reduces risks of ovarian and endometrial cancers by 50%
Decreased menstrual cramps
Pelvic examination is not required before use
Limited related side effects
Quicker return of infertility

Disadvantages

Refer to pop Side effects

Side effects

Chest pain
Amenorrhea
Spotting
High blood pressure
Nausea, dizziness & nervousness
Acne
Breast fullness & tenderness
Depression
Jaundice
Headache

Implants

Types

Implanon ( 1 rod capsule for effective 3 years)
Jadelle (2 rod capsules for 5 years)
Norplant ( 6 rod capsules labeled for 5-7 years)

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Modes of action

Thickens the cervical mucus 24 hours making it difficult for the sperm to enter the uterus.
It inhibits ovulation from taking place.

Advantages

Very effective within 24 hours after insertion
Easily reversible
No delay to return to fertility after removal
Make sickle cell crisis less frequent & less painful
Highly effective for long term
Others same as with Depo Provera

Common side effects and disadvantages

Changes in menstruations
- Spotting
- Heavy bleeding (rare)
- Amenorrhea
Does not protect against STIs including HIV/AIDs
Discomfort in the hand after insertion
Overweight or weight loss
Minor surgical procedure required for insertion and removal.

Indications

Breast feeding post-partum mothers
Adolescents
Post abortion
Women with SCD
Women waiting surgical contraception
Women on treatment e. ARVs

Contraindications

Serious problems with heart or blood vessels
Breast cancer
Liver diseases- jaundice
Pregnancy

Signs and problems that need medical attention

Soreness at the site of insertion
Capsules come out
Severe headache
Heavy bleeding twice as much and twice as long she usually bleeds
Pregnancy
Missed period after several regular period or cycles.

Injectable contraceptives

Examples

Depo provera 150mg
Injecta plan
Sayana press 104mg, 65ml subcutaneously
Noristrat 200mg intramuscularly
Norigynon 5mg intramuscularly

They both contain only one type of hormones, progestin

Depo Provera

$\"Depo$

Mode of action

Inhibits ovulation
Thickens the cervical mucus making it difficult for the sperm to enter the uterus
It also makes the lining of the womb thinner. This makes it unlikely that a fertilized egg will be able to implant in the womb.

Indications/who can use it?

Breastfeeding mothers 6 weeks after delivery or immediately if not breastfeeding
Women requiring long term contraception
Known/suspected HIV positive women who need an effective FP method
Women with sickle cell disease
Women who cannot use COC due to estrogen content
Women awaiting surgical method of contraception

Contraindications

As for POP
Women without proven fertility unless they have HIV/AIDs
Pregnancy (known or suspected)
Liver disease (jaundice)
Unexplained vaginal bleeding that has not be investigated
Hypertension 140/90mmg and above
Serious problem with the heart or blood loss
Breast or genital malignancy (known or suspected)
Women with bone thinning/osteoporosis (known or suspected)

Advantages and non-contraceptive benefits

Very effective
Does not suppress lactation
Clients only has to remember the return dates for subsequent injection
Private-no one can know that the woman is on it
No estrogen side effects
Make sickle cell crisis less frequent
If you want to stop using it you don\’t have to go back to your doctor or nurse to have it removed; you just have to wait for it to wear off.
It does not interfere with sex

Disadvantages and common side effects

Changes in menstrual bleeding
- Spotting (common in the first 3 months)
- Amenorrhea (often after 1^st injection and after 9-12months of use)
- Prolonged heavy vaginal bleeding during 1^st 1-2 months after injection
Weight gain or loss
The injection cannot be removed once given. Any side-effects will last for more than 2-3 months, until the progesterone goes from your body.
Delayed return of fertility
Loss of lido
Does not protect against STI/HIV/AIDs
Alopecia
Milk headache

Signs and problems that need medical attention

Repeated severe headaches
Excessive weight gain
Depression
Prolonged abdominal pain and pain at injection site
Heavy bleeding per vagina twice as much and twice as long as she usually bleeds

Management

Medroxyprogesterone acetate depot (Depo provera) Injection 150mg deep IM into deltoid or buttock muscle
- Do not rub the area as this increases absorption and shortens depot effect

If given after day 1-7 of menstrual cycle

Advise client
- To abstain from sex or use a back-up FP method, e.g. condoms, for the first 7 days after injection
- To return for the next dose on a specific date 12 weeks after the injection (if the client returns more 2-4 weeks later than the date advised, rule out pregnancy before giving the next dose)
- On likely side effects
- To return promptly if there are any warning signs

Sayana Press

$\"Sayana$

Sayana press ® is a single-dose container with 104mg Medroxyprogesterone acetate (MPA) in 0.65ml suspension (104mg) formulated for subcutaneous
It is administered subcutaneously into the anterior thigh or abdomen or arm
The efficacy of Sayana press depends on adherence to the recommended dosage schedule of administration.

Mechanism of actions

Its‘ main mechanism of action is to suppress ovulation
It makes the endometrium unsuitable for implantation if fertilization occurs
It also increases the viscosity of cervical mucus making the mucus less easily penetrable to sperm.

Indications

Nearly all women can use it safely & effectively including women:-

Women whose partners have undergone vasectomy until vasectomy is effective
Have or have not had children
Any age including adolescents & women over 40 years old
Have just had an abortion/miscarriage
Breastfeeding women 6 weeks postpartum
HIV infected whether or not on ART

Advantages & non- contraceptive benefits

New formulation for S/C injection
30% low side effects compared to Depo-Provera
Do not interfere with sex
Private & no one else can tell that a woman is using it
May help women gain weight
Do not require daily action
Prevents pregnancy
Protects against endometrial cancer, uterine fibroids
Reduces sickle cell crisis among women with sickle cell anemia
Protects against symptomatic PID & iron deficiency aneamia

Contraindications

Sayana press is contraindicated in the following:-

Clients with a known hypersensitivity to MPA
Pregnancy (known or suspected)
women with known or suspected malignancy of the breast or genital organs
clients with undiagnosed vaginal bleeding
patients with severe hepatic impairment
patients with metabolic bone disease
patients with thromboembolic disease
patients with current or past history of cerebro-vascular disease

Disadvantages & Side effects

Weight gain or loss
Does not protect against STI/HIV/AIDs
Delayed fertility return
Hypersensitivity reactions
Decreased/increased appetite
Loss of libido & irritability
Dizziness, headache & migraine
Thromboembolic disorders
Nausea & vomiting
Jaundice
Alopecia & urticaria
Loss of bone mineral density
Back & leg pains
Mood changes
Abdominal bloating & discomfort

Problems that may need medical attention

Loss of bone mineral density
Menstrual irregularities
Thromboembolic disorders
Anaphylaxis & anaphylactoid reactions
Sudden partial or complete loss of vision

Permanent Method/Voluntary Surgical Contraceptives

Because male and female sterilization are permanent methods of contraception, thorough counseling procedures must be followed to ensure that the client fully understands his or her choice and to minimize chances of regret. Clients younger than 30 years old or with fewer than three children require particularly careful counseling and exploration of other long-term method options.

Tubal ligation/tubectomy

This is a voluntary surgical procedure for permanent termination of fertility in women.
It can be done by a mini-operation (laparatomy/laparoscopy)

Mode of Action

Blocking fallopian tube by cutting, cautery, rings or clips
Prevent sperms from reaching the ovum

Indications

In general, the majority of women who want tubal ligation can have a safe and effective procedure in a routine in a health facility equipped to provide the service, provided they have been counseled. They should also be able to give informed consent. Women who may consider tubal ligation include:

Those who are certain that they have achieved their desired family size
Women who want a highly effective permanent method of contraception
Women for whom pregnancy presents unacceptable risk Family planning should be delayed in case of:
1. Pregnancy
2. Immediately/early postpartum if woman had severe pre-eclampsia/eclampsia, early rupture of membrane (EROM), sepsis etc.
3. Complicated abortion (infection, hemorrhage)
4. Current DVT
5. Unexplained vaginal bleeding (before evaluation)
6. Malignant trophoblastic disease
7. Current PID or purulent cervicitis
8. Current gall bladder disease
9. Severe anemia
10. Acute respiratory disease
11. Acute systemic infection or gastroenteritis
12. Abdominal skin infection – peritonitis

Timing of the tubal ligation

Immediately after childbirth or within first seven days (if she made voluntary choice in advance)
Six weeks or more after childbirth
Immediately after abortion (if she made voluntary choice in advance)
any time provided pregnancy is ruled out (but between seven days and six weeks postpartum)
during caesarean section

Benefits

Highly effective
Effective immediately
It is permanent
It is a simple surgery, usually done under local anesthesia
No exposure or worries about contraception
No further expense or worries about conception
No long term side effects
Does not interfere with sexual intercourse

Disadvantage

Does not protect against STIs/AIDs
It is irreversible

Side effects

Wound infection
Post-operative fever
Bladder and intestinal injuries(rare)
Hematoma
Pain at the incision (post operatively)
Superficial bleeding

Challenges associated with tubal ligation

Desire for more children after when the operation is done
Excessive desire in reversal
Disagrees to sign the informed consent form
Pressure from the someone else
Depression
Marital problems
Single women
Women with no children

General complications of tubal ligation

Obesity
Psychological upset
Chronic pelvic pain
Congestive dysmenorrheal
Menstrual abnormalities like menorrhagia, hypomenorrhea
Alteration in libido.

2. Vasectomy

This is a voluntary surgical procedure for permanently terminating fertility in men

Mode of action

Blocking the vas deferens (ejaculatory duct) so that sperms are not present in the ejaculate.

Indications

Those who are certain that they have achieved their desired family size
Men who want a highly effective permanent method
Men whose wives face unacceptable risk in pregnancy

Contraindications

Vasectomy should be delayed in case of:

Local infections (scrotal skin infections, orchitis etc)
Current STI
Systemic infections

Benefits

Highly effective
It is permanent
It is a simple surgery done under local anesthesia
No further expense or worries about conception
No long term side effects
Does not interfere with sexual intercourse

Side effects

Wound infection
Scrotal hematoma
Granuloma
Excessive swelling
Pain at incision sites

Explain the following to the clients

When to come back for follow up visits
Common side effects of the method offered
What to do if there are changes in the menstrual periods
How soon the method is effective
How to protect against STIs
How to care for the wound in case of implants, vasectomy and tubal ligation

General instruction to the clients using permanent methods of family planning

Inform him or her when to come back for follow up visits
Explain the common side effects of the method in a simple language
Tell the client the warning signs or possible problems that may require medical attention
Tell the client what to do if there are changes in the menstrual periods
Inform the client how soon the method is effective
Let the client know that the method does not protect against HIV/AIDs and STIs and emphasize on the use of backup methods like condoms
Guide the client on how to care for the wound post operatively

Emergency /Post Coital Contraceptives

Emergency contraception (EC) refers to methods of contraception used by women to prevent unintended pregnancy following unprotected sexual intercourse. It should not be used as a routine contraceptive method. EC not a method for termination of pregnancy

Indications

Any woman who has had unprotected sexual intercourse
Women who have been raped
Any woman whose contraceptive method has failed (e.g. condom broke or slipped)
Any woman who has forgotten to take her COC pills for more than two days or who has forgotten to take her POP at the regular time
Missed injection for more than two weeks
Delay in taking pills more than 3 hours
Sexual assault or rape and the first time intercourse

Contraindications

Pregnancy
After 120 hours or 5 days of unprotected sex

Types

Emergency contraceptive pills (ECP)
Progesterone only pills regimen.

They are the preferred ECP regimen as they are more effective and have fewer side effects than COC pills

When to start?

This should be started or taken within 5 days or 120 hours but the sooner the better following unprotected sexual intercourse.

What to use and the dose

Lofemenal or microgynon 4BD for 1 day (low dose COC)
Eugynon (high dose COC) 2BD for 1day
Regular POP such as Ovrette or microval can be used in recommended dose
Levonogestrel 2stat
Postinar 2 BD for 1day
vikela orlevonelle-2 or Norlevo plan B may be used

Side effects

Nausea & vomiting

a) Intrauterine contraceptive devices (IUCDs)

Introduction of copper IUCDs with a maximum period of 5days can prevent conception following accidental unprotected sexual exposure.

Mechanism of action

Prevents implantation
Failure rate is about 1%
Effectiveness is over 99% in preventing pregnancy

Notes

Post coital contraception is only employed as emergency measure and is not effective if used as regular method of contraception with the exception of the copper IUCDs

Women who need emergency contraception should be counseled about regular contraceptive options and encouraged to use regular methods consistently and correctly. Referral:

Women should be referred for other relevant services such as HIV counseling and testing, post exposure prophylaxis (PEP) and treatment for STIs
Women should be referred to specialized services such as for sexual and gender based violence.

Basic steps of client care for ECP

Greet client, introduce yourself, and ask what he/she
Show a respectful attitude
Explain that your discussion with the client will be kept
Explain the different ECP
Screen the client for ECP use.
Tell client about ECPs; give clear information about use, side effects, and needs for referral or follow-up.
Encourage her to ask questions
Discuss options for regular contraception with client

Counseling ECP clients

When counseling a client about ECP, the provider should:

Actively involve the client in the counseling process
Reassure the client that all information she gives you is kept confidential
Provide a private and supportive environment
Do not make judgmental comments or indicate disapproval through body language (such as such as crossing your arms over your chest)
Be responsive to the client‘s needs
Be supportive of the clients choices
Be respectful

Hormonal Methods of Family Planning Read More »

Artificial Methods of Family Planning

Artificial methods of family planning refer to the use of various techniques and devices to prevent pregnancy. These methods rely on the use of physical barriers, chemicals, or surgical interventions to either prevent sperm from reaching the egg or to interfere with the fertilization process.

FAMILY PLANNING CARD

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Criteria to follow before a client is put on a family planning methods

History taking

1. Personal Age, sex, address, next of kin
2. Social Marital status, education, any habits that may affect choices of some family planning methods e.g. smoking
3. Medical To identify the presence of medical diseases, problems, sickle cell, medications.
4. Reproductive /obstetric history:
  - Find out when clients started her period
  - How many children/pregnancies she had
5. Gynecological To identify any diseases affecting a woman‘s reproductive organs e.g. bleeding, cancer of the cervix, PIDs, breast cancer etc.
6. Family planning To find out about previous use of family planning methods.

General examination

Should be done from the head to toes;

Anemia, edema, jaundice, lymphadenopathy
Breast for colour changes, masses
Per abdominal examination to check for masses
Per vaginal examination to check for abnormal discharges

Note: Weight, blood pressure should be recorded when starting one on family planning especially the hormonal ones.

Artificial methods of family planning

Barrier methods

Spermicides
Condoms
IUCDs
Diaphragm
Intra-vaginal contraceptive sponge
Cervical caps

Condoms (male and female)

This is the most popular and oldest method
This is a rubber sheath that is worn by a woman or man during sexual intercourse
It is the only family planning method that prevents both pregnancy and STIs including HIV/AIDs if used consistently and correctly.

Indications

Condoms can be used by any man or woman regardless of his/her health status. People in particular need of condoms include:

Men wishing to participate more actively in family planning
Sexually active adolescents
Couples who have sexual intercourse infrequently
People in casual sexual relationships where pregnancy is not desired
Couples needing a back-up method while waiting for another contraceptive methods to become effective.
Couples who need a temporary method while waiting to receive another contraceptive method.
Those who are at increased risk of STIs, (e.g. when one or both partners have other partners)
Couples where one or both partners are HIV positive

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Male Condoms

Male condoms are sheaths or coverings that fit over a man‘s erect penis. Most are made from thin latex rubber; some are polyurethane (plastic).

Primary mechanism of action

Work by forming a barrier that keeps sperm out of the vagina, preventing pregnancy
Also keep infectious agents in semen, on the penis, or in the vagina from infecting the other partner

Effectiveness

Protection against pregnancy:
As commonly used, about 18pregnancies per 100 women whose partners use male condoms over the first year
When used correctly with every act of sex, about 2 pregnancies per 100 women whose partners use male condoms over the first year

Protection against HIV and other STIs:

Male condoms significantly reduce the risk of becoming infected with HIV when used correctly with every act of sex.
When used consistently and correctly, condom use prevents 80% to 95% of HIV transmission that would have occurred without condoms.
Condoms reduce the risk of becoming infected,
- Protect best against STIs spread by discharge, such as HIV, gonorrhea, and Chlamydia
- Also protect against STIs spread by skin to skin contact, such as herpes and human papilloma virus (if condom covers lesions)

Any client concerns or questions

Reinforcing correct condom use and reminding clients that condoms should not be reused
Allergy to latex

Dispelling myths regarding condoms

Male condoms:

Do not make men sterile, impotent, or weak
Do not decrease men’s sex drive
Do not promote promiscuity
Cannot get lost in the woman\’s body
Do not have holes that HIV can pass through
Are not laced with HIV
Do not cause illness in a woman because they prevent semen or sperm from entering her body
Do not cause illness in men because sperm may move back up
Are used by married couples; they are not only for use outside marriage

Who should not use condoms?

Individuals allergic to latex should consider other contraceptive options. However, for those at risks of STIs/HIV, condom use is still appropriate as there are no other methods that offer STI/HIV protection.

How to use male condoms

Use a new condom for each act of sex. Check package for damage and check the expiration Tear open carefully without using any sharp objects.
Before any physical contact, put condom on the tip of the erect penis with the rolled side out.
Unroll condom all the way to the base of the erect penis.
Immediately after ejaculation, hold rim in place and withdraw penis while it is still Slide the condom off, avoiding spilling semen.
Dispose of the used condom safely.

Practices to avoid when using condoms

Unrolling condom before putting it on
Using oil-based lubricants with latex condoms
Using condoms that may be old or damaged (e.g. dried out, brittle, sticky)
Reusing condoms

Practicing dry sex as it increases possibility of condom breakages due to friction

$\"Artificial$

Female Condoms

Female condoms are sheaths, or linings, that fit loosely inside a woman‘s vagina
Most common type is Female Condom Two (FC2) made of thin, soft, synthetic rubber film, with flexible rings at both ends
Latex female condoms are available in some countries Primary mechanism of action
Work by forming a barrier that keeps sperm out of the vagina, preventing pregnancy
Also keep infectious agents in semen, on the penis, or in the vagina from infecting the other partner

Effectiveness

Protection against pregnancy:

When used correctly with every act of sex, about 5 pregnancies per 100 women using female condoms over the first year
As commonly used, about 21 pregnancies per 100 women using female condoms over the first year.
Protection against HIV and other sexually transmitted infections (STIs):
Female condoms reduce the risk of infection with STIs, including HIV, when used correctly with every act of sex.

Characteristics of female condoms

Safe
Women can initiate their use
Have a soft texture that quickly conducts body heat during sex
Provide dual protection (against STIs/HIV and pregnancy)
Outer ring provides added sexual stimulation for some women
Do not require provider‘s help
Can be inserted ahead of time so do not interrupt sex
Are not tight or constricting like male condoms
Do not dull the sensation of sex like male condoms
Do not have to be removed immediately after ejaculation
No side effects
Can be used as a temporary backup method of contraception
Protect women from conditions caused by STIs (pelvic inflammatory disease, cervical cancer, infertility)
As typically used, less effective than many other FP methods
Require partner communication and cooperation
May be difficult to insert
Can make noise during sex

Side effects of female condoms:

None
Allergic reactions to latex

Who can use female condom?

All men and women can safely use synthetic rubber female
All men and women can safely use natural latex female condoms, except those with a severe allergy to latex (extremely rare).

How to use female condoms

Use a new condom for each act of sex.
- Check the condom
- Do not use if torn, damaged or past the expiration
- Open the package
Before any physical contact, insert the condom into the vagina. It can be inserted up to eight hours before sex. Find a comfortable position for insertion—squat; raise one leg, sit, or lie down. Grasp the ring at the closed end, and squeeze it so it becomes long and With the other hand, separate the outer lips and locate the opening of the vagina. Gently insert the inner ring into the vagina as far up as it will go. Insert a finger into the condom to push it into place. (The inner ring should be pushed up just past the pubic bone.)
Ensure that the penis enters the condom and stays inside the
To remove the condom, hold and twist outer ring to seal in fluids, and gently pull condom out of the vagina. The female condom does not need to be removed immediately after sex, but any time before standing up, to avoid spilling semen.
Dispose of the used condom safely.

Tips for new users

Suggest to a new user that she practice putting in and taking out the condom before the next time she has sex. Reassure her that correct use becomes easier with practice. A woman may need to use the female condom several times before she is comfortable with it.
Suggest she try different positions to see which way insertion is easiest for her.
The female condom is Some women find insertion easier if they put it in slowly, especially the first few times.
If a client is switching from another method to the female condom, suggest that she continue with the previous method until she can use the female condom with confidence.

Provide follow up and counseling for

Any client concerns or questions
Correct condom use

Dispelling myths regarding female condoms

Female condoms:

Cannot get lost in the woman‘s body
Are not difficult to use, but correct use needs to be learned
Do not have holes that HIV can pass through
Are used by married couples; they are not only for use outside marriage
Do not cause illness in a woman because they prevent semen or sperm from entering her body

General Advantages

Effective when used correctly
No medical supervision required
Convenient to carry
Prevents both pregnancy and STIs including HIV/AIDs
Easy to use
Reduce risk of systemic side effects and reaction
Fairly cheap and available in almost every places

General Disadvantages

There is loss of spontaneity
May rupture or lose position during intercourse
It is often associated with extra marital sex and STIs
It is not suitable for poorly motivated persons
There is lack of privacy while purchasing condoms
It cannot be used by a man who cannot maintain erection
Requires male responsibility
It is considered unclean to some people

$\"\"$

Spermicides

This involves application of chemicals into the vagina to prevent pregnancy.

Mode of action

Aims at killing or inactivating sperms

Forms of Spermicides

Jellies
Creams
Foams
Tablets
Lubricants in condoms
Ingredient in vaginal sponge

Advantages

Available without prescription
Fairly effective if used correctly
Can be used as backups
Used only if required
Control is in the hand of a woman
Provide extra-vaginal lubrication
Protects against some STIs and PIDs

Disadvantages

Not effective when used alone
Some couple find the method messy i.e. too fluidic
Associated to some allergic reaction
Interrupts sexual intercourse

$\"artificial$

Intra-Uterine Contraceptive Device (IUCDs)

These are devices inserted into the woman uterus to prevent implantation of the fertilized ovum by local inflammation.

Types of IUCDs

Copper T 380A effective for 10-12 years
Multi-load 375 for 5 years
Mirena R hormonal IUCD

Advantages

It is very effective since it starts working right way
She does not need to keep coming for refill
Can offer protection up to 10 years and above
Fertility returns is immediate
Limited side effects reported as compared to other methods
Does not interfere with sexual intercourse
Has no effects on breastfeeding
Only one follow up is needed unless there are problems

Side effects

Increases menstrual bleeding
Spotting
Abnormal vaginal discharge
Menstrual cramps
PID

Indications

Breastfeeding
Women of any age
As for POP

Contraindications

Irregular vaginal bleeding of unknown origin g. cancer of cervix
Pregnancy
Heavy and painful menstruation
Cancer of the uterus
Current PIDs
Multiple sexual partners
Pregnancy

IUCDs users who develop PID should be treated with the IUCD in place if they want to continue using it. If no improvement within 72 hours, remove it.

Insertion of IUCD Timing of IUCD insertion

Any time provided pregnancy is ruled out
The first seven days of the menstrual cycle
Immediately following delivery or any time within 46 hours after childbirth
Any time beyond four to six weeks after childbirth
Immediately or within seven days after an uncomplicated abortion
During caesarean section

Procedure

Consider aseptic technique like hand washing, wearing sterile gloves.
The device is put in an introducer and plunger.
It straightens inside the introducer.
Insert a Cusco ‘s vaginal speculum and clearly visualize the cervix.
Clean the cervix and vaginal vault with sterile swabs.
Measure the length of the uterus with a uterine sound.
Insert the introducer into the uterus through the cervix.
The plunger is gently pushed to force device out of the introducer into the uterus.
In the uterus, the device resumes its original shape and lodges against the uterine walls.
The two small strings attached to the device hang down through the cervical opening.
Cut the string with a pair of scissors to reduce the size approximately 3cm hanging out of the cervix.
After the insertion, the client She can remain on the procedure table until she feels ready to get dressed.
The woman usually feels the strings in the vagina to ensure that the device is in position.

Post insertion instructions

To use back up for a minimum of 3 days.
There may be some slight pain which does not require medication.
To check the string during menstruation to ensure that it is in place or come back if it is removed or dislodged.
To return to the facility immediately in case of any discomfort.

Removing the IUDs

In case a client is finding side effects difficult to tolerate, first discuss the complaints the client has. Weigh if she would rather try to manage the problem or to have the IUD removed.
Removing IUD is usually It can be done any time of the month.
Removing may also be easier during monthly bleeding, when the cervix is naturally In cases of uterine perforation or if removal is not easy, please refer the client to an experienced service provider to employ appropriate removal technique.

Steps for IUD removal

Explain what you are going to do to the client during removal
Ensure privacy & confidentiality at all times
Request the client to lie on her back
The provider inserts a vaginal speculum to visualize the cervix & UID strings
Carefully cleans the cervix & vagina with an antiseptic solution such as Savlon & do inspection
The provider requests the client to take slow, deep breaths & to Inform the client to make you know in case she feels pain or any other discomfort during the procedure
Using narrow forceps, the provider gently pulls the IUD strings & slowly until it comes completely out of the cervix
Show the removed IUD to the client & let her handle with the hands. This helps to make the client understands that nothing has remain inside the uterus.
Thank the client for cooperating throughout the procedure
Clear away

Reasons for missed threads in IUDs

Coiled thread inside
Thread torn through
Device expelled outside unnoticed by the client
Device perforated the uterine wall and is lying in the peritoneal cavity
Device pulled by the growing uterus in pregnancy

Methods of identification

History taking i.e. exclude pregnancy
Ultrasonography
Hysterectomy
Hysteroscopy
Straight x-ray

Hormonal Methods of Family Planning (Click Here)

Artificial Methods of Family Planning Read More »

Family Planning

Family Planning is defined as a process through which individuals, couples make up an informed choice on how many children to have, when to have and how often to have so that each child born is expected and properly catered for in all ways.

For instance, basic needs like good health, education, shelter, and all essential needs of humans are available.

This involves planning and proper birth spacing according to wishes rather than by chances. Birth spacing promotes the health of the mother, children and father.

Consent for family planning services

No verbal or written consent is required from parent, guardian or spouse before the client can be given family planning services except in cases of incapacitation (intellectual disability). Clients should give written consent to permanent family planning methods.

Setting of family planning clinics

Service delivery points where a health provider comes into contact with a potential or actual client

Social mobilization events for any health services
Youth clubs and schools through family life education activities
Women and men organized clubs/groups
Work places

Where to get family planning services

- Facility based outlets such as hospitals, health centers and dispensaries
- Outreach services including mobile clinics and workplaces
- Community based outlets e.g. community based distribution, drug shops and dispensing machines
- Social marketing
- Private sector facility such as clinics, maternity and nursing homes, pharmacies and drug retail shops

Counseling

In order to promote informed choice, all clients seeking contraceptives are entitled, given accurate and adequate information about family planning methods available in the common settings. This is important for the initiation and continuation of family practice. Methods (of choice) of clients will be done individually and in a dignified manner. The discussion between the service provider and client must be private, confidential and should never include incentives or coercion for the adaptation of any method.

Initial counseling should include the following:

Discussion of client’s reproductive goals, previous knowledge and/or experience with any method
Showing the FP methods available
Information on how each method prevents pregnancy
How effective the method is and what conditions make I effective
Method failure
Common side effects
The follow-up regarding each method
Where the method can be obtained
Importance of physical and pelvic examination
Information on HIV/AIDs/STIs in relation to F/P
HIV testing and screening of STIs
Symptoms of breast and cervical cancer including available services for screening
Clarification of misconceptions or rumors the client may have about each type of method

Subsequent counseling will aim at promoting and encouraging continued use of a method and should include:

A review of the client ‘s satisfaction or problem with the method
A review of the client ‘s understanding of user instructions
Dispelling rumors and/or misconceptions, if any
In indicated, a review of change of the client’s reproductive goal necessitating the need for a long term or permanent method
Counseling on STIs and HIV/AIDs
Possible method failure
Information of common symptoms of breast and cervical cancer including available services for screening
Counseling is also important:
Where a contraceptive method has failed
There is regret for having had a permanent method
In cases of rape or defilement
Where there are is need for referral for appropriate care

Screening

After a thorough counseling a client should then be ready to choose a contraceptive method. The next step is to screen for contraceptive use.

Clients opting for hormonal method should have the relevant health, social history taken and physical assessment carried out on the first or subsequent visits. Where indicated, do a complete physical check up to rule out contra-indications to method use. Where is not possible or necessary to perform routine physical assessment, the client should be screened by a qualified staff or FP trained service provider using a standard checklist to initiate or resupply oral contraceptive or Depo Provera. After screening, the important findings should be communicated to the client including any issues she/he may want clarification on. The client will then be provided with the appropriate or preferred method and important findings should be recorded according to the guidelines.

Routine physical or pelvic examinations is not obligatory for initiating or re-supply of oral contraceptives or Depo Provera, an examination could be valuable for reproductive health and may help to rule out contra-indications to methods and/or establish the presence or absence of infections or cancer.

Where selected physical assessment or laboratory tests are indicated and is not possible to carry them out at a particular clinic, clients should be referred to a health unit equipped to provide the assessment test.

Importance of family planning

a) To the mother

Allows mother to recover physically and mentally from the effects of previous pregnancy
Offers ample time for a woman to actively participate in productive activities like farming and business.
It increases social bondage between the mother and her baby
It helps to reduce on maternal mortality and morbidity the couples due to pregnancy related complications
It promotes a happy marital life and enjoyment between the couples without fear of getting unwanted pregnancy.

b) To the child

Child receives adequate emotional and social support and as a result gets emotional maturity and stability
Allows adequate nutrition of the baby while in the womb and hence a healthy newborn
There is reduction of malnutrition as there is no early weaning and likely to have enough food for the child
The child gets fewer infections since immunity is

c) To the father

Reduces domestic violence in a home
Ability to meet basic needs like foods, medical care
Reduces the cost of living in a home hence the father is able to invest in productive

d) To the Community

Healthy and productive people who enhance community stability and harmony
Reduces overcrowding hence available land can be maximize for productivity
There will be increased socio-economic development
Presence of bad characters in the community like street kids, smokers and other bad group in the community since parents have adequate time to provide for their

e) To the Nation

Reduces rapid population growth rate
Reduces the country‘s dependence on foreign aids
The government will be able to provide better social services and infrastructures like roads, health facilities
It is easy to budget for the people since the number of resources to the population is

Available family planning methods in Uganda

The family planning methods can be broadly classified into: –

Natural family methods.
Hormonal /Artificial family planning.

1. Natural /traditional methods

Calendar/rhythm
Basal body temperature
Cervical mucus method
Lactation amenorrhea methods
Abstinence
Withdrawal/coitus interrupters

2. Artificial methods

Barrier methods

Spermicides
Condoms
Intrauterine contraceptive devices (IUCDs)
Diaphragm

b) Hormonal methods

Oral pills
- Combined oral contraceptives
- Progesterone only pills
- Emergency contraceptive pills

ii. Implants

Implanon (1 rod capsule)
Jadelle (2 rod capsules)
Norplant (6 rod capsules)

iii. Injectable contraceptives

Depo Provera
Injector plan
Sayana press
Noristerat

c) Permanent methods

Tubal ligation (tubectomy) for women
Vasectomy for men

Natural methods of family planning

These are also known as fertility awareness method. They are based on the following physiological conditions.

The lifespan of a sperm is 24 hours
The lifespan of an ovum is 48 hours
Menstruation takes place between 1-16 days before the next period

General advantages

They are safe with no side effects
Cheap
They are acceptable to many groups and religious that opposes the modern methods
They teach women about their own menstruation cycle and fertility
Couples have control over their methods
Help in planning a pregnancy

General disadvantages

Some require substantial teaching before use
It is difficult as records on several cycles ought to be kept for proper references
Difficult to use if the period are irregular
Requires adjustment to sexual behaviors
Requires co-operation between the partners which in most cases is difficult
Do not protect against STIs/HIV/AIDs

Fertility awareness method

Fertility awareness methods of family planning involve identification of the fertile days of the menstrual cycle (when pregnancy is most likely to occur) and avoiding sexual intercourse (or using barrier methods) during these days. The fertile days of the menstrual cycle can be determined by one of the following methods:

Basal body temperature (BBT)
Cervical mucus
Symptom- thermal (a combination of cervical mucus and BBT methods)
Calendar (rhythm) or Standard Days method, including cycle

A woman or couples who are planning to use fertility awareness methods need special training from a trained counselor in family planning.

Indications

Any woman or couple who is willing and motivated to observe, record and interpret fertility signs daily.

- Women who find other contraceptive methods unacceptable for various reasons including religious beliefs
- Women who are unable to use some other methods for health reasons
- Couples who are willing to abstain from sexual intercourse (or use condoms) for more than one week during each days

Contraindications

There are no medical conditions that are worsened with the use of fertility awareness methods. However, there are some conditions that make their use more difficult. If these conditions are present, the method can either be delayed or the provider should offer special counseling to ensure the correct use.

These conditions include:

Breast feeding (especially until menses return)
Less than three postpartum menses
Irregular vaginal bleeding
Abnormal vaginal discharge
Disease that evaluates body temperature

$\"Calendar$

Calendar /rhythm method

This is the only method approved o the Roman Catholic Church
Before starting to use this method, one needs to have an accurate record of menstrual cycles for about 6-8 months
The failure rate is between 20-30%
The method is referred to as ―safe days‖ because it aims at identifying days with least chance of conception
The woman should provide a record of her menstrual cycles to the health worker and then go into the calculation as shown below.

Calculating the fertile period

Fertile period is the time of the cycle when a woman has the ―highest ―chances of conception.

Procedure

Record the length of each Length of a cycle is the time between the first day of one menstruation period and the first day of the following period
Identify the shortest and longest cycle
Get the first fertile day (FFD) by subtracting 18 from the shortest cycle (16 + 2 days of sperm survival)
Get the last fertile day (LFD) by subtracting 11 from the longest cycle (12-1 day of ovum survival)

Examples

A woman with a regular cycle of 28 days duration report to the family planning clinic and has opted for calendar method. Demonstrate the ability to calculate this in order for her to start using the method.

Record the length of each menstrual cycle: This is the time between the first day of one menstruation period and the first day of the following period.
Identify the shortest and longest cycles: Determine the cycle with the fewest days as the shortest cycle, and the cycle with the most days as the longest cycle.
Calculate the first fertile day (FFD): Subtract 18 from the duration of the shortest cycle. This accounts for the fact that sperm can survive for about 2 days.
Calculate the last fertile day (LFD): Subtract 11 from the duration of the longest cycle. This considers the fact that the ovum (egg) can survive for about 1 day.

Here\’s an example to demonstrate how to apply this method:

Examples

A woman with a regular cycle of 28 days duration report to the family planning clinic and has opted for calendar method. Demonstrate the ability to calculate this in order for her to start using the method.

Given: Number of cycles: 28 days

To calculate:

Shortest cycle: 28 – 18 = 10th day

Longest cycle: 28 – 11 = 17th day

Interpretation:

The woman is highly fertile between the 10th and 17th days of her cycle.

Comments/Remarks:

It is recommended to avoid sexual intercourse between the 10th and 17th day of her cycle.
It\’s advisable to use condoms or another form of contraception as a backup method.

2. A woman with irregular cycle whose shortest cycle is 25 days and the longest cycle is 32. Calculate and interpret he finding to the client

Solution

Given number; Shortest cycle =25 days Longest cycle=32 days

Therefore:

FFD=shortest cycle=shortest cycle-18 =25-18 =7^th day

LFD=longest cycle-11 =32-11 =21^st day

Interpretation

A woman is very fertile between 7^th-21^st day of every cycle
Avoid sexual intercourse between 10^th-17^th day of her cycle
To always use condoms or any other family planning method as a dual or backup

Self-help assessment

Demonstrate your ability to calculate & interpret the following to the client:-

A client with cycle of 29 regular
A client with cycles of 24 & 30 days respectively (irregular cycles)
A client with 27 day cycle (regular)

Advantages

No cost
No side effects
Refer to general advantages of natural methods of family planning

Disadvantages

Difficult to calculate the safe period reliably
Needs several months training to use these methods
Compulsory abstinence from sexual act during certain periods
Not applicable during lactation amenorrhea when the periods are irregular
Does not protect against STIs including HIV/AIDs

Lactation amenorrhea method

Immediately after birth, there is a period of naturally decreased fertility which can be prolonged by regular breastfeeding. The hormone responsible for the suppression of fertility is prolactin that controls milk production.
The effect of breast feeding on reducing fertility awareness is well known. However, LAM is a temporary 9 short- term) method of contraception. It is highly effective for the first six months after delivery, providing the woman breastfeed fully and remains amenorrhoeic.
In non- lactating mothers, prolactin gradually decreases within weeks after child birth reaching normal levels in about 4 weeks post-partum.
Regular nipple stimulation by sucking is necessary to maintain milk production and lactation amenorrhea method.
LAM may last up to 24 months during a regular prolactin release which inhibits the ovarian functions
When all three criteria of LAM are met, it is about 98%

Indications

Women who are fully breastfeeding and
Who are amenorrhoeic (no menses) and
Whose baby is not older than six months

Fully breastfeeding means:

Breast feeding whenever the baby desires (at least every four hours)
Night time feeding (at least every six hours)
Not substituting other food or drink in place of breast milk

Who cannot use LAM/contraindications?

Women whose menses have returned.
Women whose babies have turned six months old.
Women who have introduced supplementary feedings.

Note: Women with HIV should be counseled about the infant feeding options to reduce risk of mother-to-child transmission and be supported in their choice. Women without reliable access to safe alternative feeding options should be encouraged to breast feed exclusively for six months

Standard Days Method (Moon beads/cycle beads)

The Standard Days Method® is a fertility awareness-based family planning method that identifies a fixed fertile window for women with cycles that are between 26 and 32 days long. For women with cycles in this range, the method identifies days 8 through 19 as potentially fertile days. A user simply tracks the start date of her period and the days of her cycle to know if she is on a day when pregnancy is possible or not.

What are moon beads?

They are string of colored beads
The colors of moon beads help you know the days when you can get pregnant
They also help you know the days you are not likely to get pregnant
To prevent a pregnancy do not have sex on the days you can get pregnant, or use a barrier method.

Note: Moon beads are based on a natural method of family planning that is 95% effective when used correctly. This means that only 5 out of 100 women may become pregnant when the method is used correctly.

Modes of action

If a woman wants to prevent pregnancy using this family planning method, then she should avoid intercourse or use a back-up birth control method such as condoms during her fertile days (days 8-19). The patented Cycle Beads tools help a woman use this method by tracking her cycle, identifying her fertile and non-fertile days based on when her period started, and confirming that her cycles are in range for effective use of this family planning method.

Moon beads and the menstrual cycle

Moon beads represent a woman‘s menstrual cycle
Each bead is a day of the

Note: The menstrual cycle is not the same as the woman‘s period. The period is when a woman has menstrual bleeding while cycle includes all days from the start of one period to the day before the next period.

Indications/Eligibility/who can use it

Couples who communicate well and agree not to have unprotected sex when the woman is likely to get pregnant
Women who have failed to use other modern methods
Women who have cycles that is between 26 and 32 days

Advantages

Refer to natural methods
More than 95% Effective
Side-Effect Free
Easy to Use
Inexpensive
Educational & Empowering

How to use moon beads

The day you get your period, move the ring to the RED bead.
Also mark that day on the calendar
Move the ring, one bead each day
Do not have unprotected sex when the ring is on any WHITE bead. You can get pregnant on those days
You can have sex when the ring is on any brown beads. You are not likely to get pregnant on those days
Move the ring to the RED bead again when your next period starts. Skip over any beads that are left.

$\"MOON$

When to contact the healthcare provider

Had unprotected sex on a WHITE bead If she thinks she might be pregnant because she has not gotten her period.
If she gets her period before she reaches the DARK BROWN beads, this means that her cycle is shorter than 26 days.
If her period does not start by the DAY AFTER she reaches the last brown bead, this mean that her cycle is longer than 32

Family Planning Read More »

Antenatal Care in Reproductive Health

Antenatal care; antenatal care is a planned program of medical management of pregnant women directed towards making pregnancy, labour a safe and satisfying experience.

The health of pregnant women would be improved if effective antenatal care (ANC) was available to all. Antenatal care therefore, constitutes one of the cornerstones to safer motherhood. It is suggested that more flexibility concerning the place of consultation and timing of visits could lead to better attendance and consumer satisfaction. The ministry of health therefore recommends integration of services, e.g. family planning, EMTCT focused antenatal care, immunization etc.

Aims/purposes of antenatal care

To promote and maintain the physical, mental and social health during pregnancy.
To detect and treat conditions pre-existing or arising during pregnancy whether medical, surgical or obstetric.
To prepare the mother for the safe birth of the child for emergencies, complications.
To achieve delivery of a full term healthy baby or babies with minimal morbidity to mother.
To help the mother to experience normal puerperium and in conjunction with the partner to take good care of the Childs‘ physical, psychological and social needs.
To recognize deviation from normal and provide management or treatment as required by ensuring privacy at all times.
To prepare the mother for successful breastfeeding and give advice about adequate preparation for lactation.
To offer nutritional advice to the mother.
To offer advice on parenthood either in a planned program or an individual basis taking into consideration the clients‘ concerns.
To build up a trusting relationship between the family, the mother and health workers which will encourage them/her to share their anxieties, fears about pregnancy and care being given through adequate communication and counseling.
During this time, the pregnant woman is provided with previous preventive and advisory services. The health worker makes consultation with her regarding the most appropriate place of delivery of the baby and the things she needs to prepare emphasizing the concept of a clean safe delivery e.g. having maama kits.

Goals of Focused/Oriented Antenatal Care

Important:

– Goals are different depending on the timing of the visit. 4 visits are aimed for an uncomplicated pregnancy.
– If a woman books later than in the first trimester, preceding goals should be combined and attended to. At all visits, address any identified problems, check BP and measure the symphysio-fundal height (SFH)

To promote maternal and newborn health survival through:

∙ Early detection and treatment of problems and complications.
∙ Prevention of complications and disease.
∙ Birth preparedness & complication readiness.

Scheduling and timing of goal/focused antenatal care visits

∙ First visit: by 0-16 weeks or when a woman first thinks she is pregnant.
∙ Second visit: at 16-28 weeks or at least once in the second trimester.
∙ Third visit: at 28-32 weeks
∙ Fourth visits: if complication occurs, follow-up or referral is needed, woman wants to see a provider, or provide changes frequently based on findings (history, exam, testing) or local policy.
∙ Refer

Risk factors during pregnancy

The following conditions are considered to have adverse effect on the course and outcome of pregnancy and therefore are considered risk factors:

Conditions likely to recur and cause bleeding:

– Previous hemorrhage, APH, PPH, retained placenta
– Too many pregnancies of five (5) or more
– Aneamia
– Multiple pregnancy
– Uterine scar.

Conditions that affect intrauterine fetal growth and may cause abortion or premature – Preeclampsia

– Aneamia
– Malnutrition
– HIV
– Malaria, smoking, maternal underweight due to malnutrition
– Birth less than 2 years apart
– Diabetes
– Multiple pregnancy
– Excessive alcohol
– Sickle cell disease
– Abortion in the last 3 months

Conditions that pose risk of infections to mother and baby and may cause abortion – HIV infection

– STIs e.g. syphilis
– Early rupture of membranes
– Diabetic mellitus
– Malaria

Conditions where delivery may have to be assisted by cesarean section or vacuum extraction.

– Short stature below 150cms
– Young primigravida below 18 years
– Elderly primigravida above 35 years
– Previous uterine scar
– Cardiac disease
– Diabetes mellitus
– Injury or deformity of the pelvis and lower part of the spine. 5. Severe pre-eclampsia and eclampsia

Other conditions which are likely to:

a) Recur

– Abortion
– Stillbirth
– Premature delivery
– Eclampsia

b) Worsen with pregnancy

– Renal disease
– Mental illness
– Epilepsy
– Pulmonary tuberculosis
– Heart disease
– AIDs
– Diabetes mellitus

c) Cause social discomfort

– Lack of support from partner/family
– GBV
– Low socio-economic status
– Unwanted pregnancy

Conditions likely to cause abnormalities or disease to the baby – Age of mothers above 35 years

– STDs such as syphilis, HIV infection etc.
– Some drugs used to treat other conditions in the mother e.g. Tetracycline

Methotrexate
Efavirenz
Ciprofloxacin

– Alcohol consumption and smoking including passive smoking. – Some genetic diseases e.g. hemophilia, Sickle cell disease

Common problems that may complicate pregnancy and its management

– Aneamia
– Malaria
– STDs
▪ HIV
▪ Gonorrhea
▪ Syphilis
▪ Vaginal/vulvar warts
– Urinary tract infection

Roles of health workers in reducing the dangers of risk factors facing pregnant women

Health education targeted at the community and pregnant women , giving them sufficient time to express their concerns and discuss them
Identification of pregnant women at risk of recurrent conditions or developing complications such as pre-eclampsia and eclampsia, cephalo-pelvic disproportion etc. and refer them appropriately
Discuss the birth plan and emergency preparedness with the mother and another person of her choice.
Prepare management of pregnancy
Appropriate referral of women with risk factors.

Services offered during antenatal care

✔ Health education
✔ Counseling
✔ Screening and risk assessment through

– History taking
– General and abdominal examination
– Investigations
– Vaginal pelvic examination where applicable
– STIs testing including HIV

✔ Provision of hematinic
✔ Deworming
✔ Immunization against tetanus (TT)
✔ Intermittent presumptive treatment of malaria (IPT)
✔ Early recognition, management and referral of high risk mothers and those who develop complications
✔ Delivery and postpartum care plan for every woman.
✔ Treatment of medical conditions e.g. malaria, hypertension, diabetes, STIs, Pulmonary tuberculosis
✔ PMTCT, EMTCT

In order to offer the services at ANC, the clinic should have at least the following:

Waiting room: space where mother assemble for antenatal education: – Reception table

– Benches for clients to sit on

An examination room with privacy
A stable and firm examination couch
Weighing scale, a height measure in centimeters, a tape measure, a clinical thermometer, urine testing kits, BP machine, a stethoscope and a fetoscope.
A small laboratory capable of screening for common problems such as aneamia, hookworm infestations, syphilis, pre-eclampsia and diabetes.
Essential drugs spelt out for health centre including vaccines such as TT, SP, hematinic, elimination of mother to child transmission of HIV/AIDs (EMTCT) drugs.

The following are also recommended

Mothers should be advised to attend ANC as early as possible preferably to have the first attendance during the first sixteen (16) weeks of pregnancy
ANC should be integrated in other family health services and offered on a daily basis
Outreach ANC services outside the established health facilities should be held on specified and regular days of the week which should be known by the general public in the area.

Health Education

Aims

To provide clients with information that will help a pregnant woman to ensure that she remains healthy throughout pregnancy and delivery.
The information should be given at appropriate periods including during follow up visits.

Some key messages include the following:

– Services offered to pregnant women during ANC and benefits of ANC. – How to keep health during pregnancy
– STIs and other effects on pregnancy and newborn
– Malaria and its complications during pregnancy
– Minor disorders of pregnancy and how to cope with them
– Diet during pregnancy and lactation
– Danger signs during pregnancy and labour
– Pregnant women who must be attended to and delivered in hospital
– Benefit of family planning and different options
– Women who are likely to get problems if they become pregnant
– What to prepare for delivery
– Signs of labour
– Benefits of delivery under a skilled provider in a health unit
– Family planning methods of postpartum mothers
– Postnatal care
– Benefits of breastfeeding

Steps in planning maternal health client education session

✔ Identify target group
✔ Identify needs of target groups e.g.

– Present knowledge and practices in R.H
– The priority message related to problem

✔ Best media approach and language
✔ Identify resources such as:

– Leaders in the community
– Influential supporters of RHS for example, old acceptors of RHS
– Materials/visual aids relevant to the topic
– Venue/ that is conducive for effective RHS client education session

Preparation

✔ Prepare venue, which is conducive for the session delivery
✔ Notify target group through their leaders in the community
✔ Prepare yourself
✔ Identify satisfied clients
✔ Prepare influential supporters of RHS
✔ Prepare materials/visual aids
✔ Prepare contents and channels for delivering it, e.g. a song or a talk

Steps in conducting education session talks;

Introduction of self and colleagues
Acknowledge leaders and group present
State purpose of the session in a stimulating way by use of a slogan, poster or small story
Deliver content allowing groups to participate and use visual aids where appropriate
Allow for questions and answers
Evaluate the sessions, using simple methods e.g. observing group participation, asking a few questions while referring to the contents, getting to know and understand their feelings, learning and how they will use this knowledge
Summarize key points
Give follow on information e.g. where one can obtain individual attention
Allow them to select a topic among R.H topics
Announce where the next session will be held
Thank the group for participating

Antenatal Risk Assessment

This is an evaluation carried out on pregnant women during the antenatal period to screen them from the probability of these women who are likely to develop poor pregnancy outcome during childbirth, detection and management of any illness or pregnancy complications as they arise.

First Antenatal Visits/Booking Visit

The purpose of this visit is to obtain the baseline information against which subsequent findings in a woman will be assessed.

This baseline information is obtained through:-

✔ History taking
✔ Physical taking – General, systemic and abdominal examination
✔ Investigations

History taking

This is done in a proper and orderly manner to assess the health status of the mother and fetus.

History must include:-

✔ Name and place of residence, noting accessibility to medical and maternity care
✔ Age: noting the high risk age of below 18 and above 35 years
✔ Parity: noting the young and elderly primigravida, those above Para 4 and closely spaced pregnancies (>2 years in between)
✔ Social history, inquire whether married, source of social and financial support, education status, genital mutilation, where applicable, alcohol, smoking, health of partner.
✔ Medical history e.g. hypertension, renal disease, epilepsy, diabetes mellitus, sickle cell disease, asthma, TB and HIV, surgical history, operation, blood transfusion, skeletal deformity, fractures of pelvis, spine and femur.
✔ Obstetric and gynecological history, inquire about previous pregnancy and their outcomes such as previous cesarean section, previous retained placenta, PPH, still birth, prolonged labour and early maternal death, ectopic pregnancies, D & C , APH, pre-eclampsia etc.
✔ Family e.g. history of hypertension, diabetes in her family, twins, sickle cell disease.
✔ Menstrual history:-

– Information on the woman‘s‘ menstrual history is obtained and recorded e.g. age at menarche, length and regularity of the cycle, duration and amount of menstrual flow.
– Contraceptive history e.g. use of modern contraceptive methods and dates of discontinuation should be noted.

✔ History of present pregnancy:- Information regarding the first day of LNMP is obtained and the expected date of delivery (EDD) calculated. This will guide the provider during examination to compare the weeks of amenorrhea with the height of fundus. If pregnancy is over 20 weeks, dates of quickening should be noted. Any problems encountered since she became pregnant should be probed into and noted e.g. bleeding, vomiting, hospitalization, HIV sero-status and diseases like fever, cough, and diarrhea.

Physical examination

General

A physical examination from head to toe should be performed and note nutritional state and illness which may not be related to pregnancy:-

✔ Measure the weight, noting those that are underweight or over- weight (below 45 Kg and above 80 Kg)
✔ Measure height and note those below 159Cms and check for skeletal deformities or limping.
✔ Take blood pressure- note those with BP 140/90 mmHg and above
✔ Check for anemia and jaundice by examination of the conjunctiva, tongue, palm of the hand and capillary refilling in the nail beds
✔ Check for oedema of feet, hands, face and sacral area
✔ Carry out a systematic examination of the respiratory and cardiovascular systems to exclude abnormalities.
✔ Examine breasts for possible masses and signs of breast malignancy, educate women to care the nipples and teach herself breast examination
✔ Assessment of physical abuse:

– Drug abuse
– Bruising

✔ Assessment of any complaints

Abdominal examination

The abdomen should be adequately exposed to show important landmarks.

✔ Inspect the abdomen and note:

– size, shape of abdomen and presence of scar that may indicate a previous uterine operation
– presence of fetal movements

2. ✔ Palpation of abdomen noting:

– presence of enlarged liver, spleen and tenderness of renal angles
– Height of fundus and compare it with the weeks of gestation. excessive enlargement of abdomen, maybe an indication of multiple pregnancy or presence of polyhydramnios
– The lie, presentation, position, any tenderness and the amount of liquor.

3. ✔ Auscultation. listen to fetal heart noting the rate, volume and rhythm

Inspection of the vulva

This should be done to detect lesions of the vulva, vagina and abnormal discharge. Note any scars at the perineum or vulva. If an abnormal discharge is detected and there are facilities for gram stain, take of specimen for analysis. If there are no laboratory services, use the STI ―syndromic approach to provide treatment to the mother.

Laboratory Investigations during Antenatal Care

Baseline investigations:

– Hb (normal 10.5-15gm)
– Blood group (ABO and Rhesus factor)
– Urinalysis (protein and sugar)
– VDRL, RPR for syphilis

Special Investigations (Refer When Necessary)

– Rhesus antibodies for RH-ve mothers
– Random blood sugar where there is a history or presence of glycosma
– Mid-stream urine for culture and sensitivity
– High vaginal swab (HVS)
– Elisa test for HIV
– Sickling test

Others

– Provide TT to complete the recommended schedule for immunization against tetanus. this is routinely done to protect the mother and neonate from tetanus
– Explain to the mother the importance of tetanus immunization

Recording, Assessing Findings and Planning For Management

✔ After examination, all finding should be recorded on ANC clients‘ card and register
✔ Review findings on history, examination and investigations
✔ Share plans for next steps
✔ If the woman has to be referred, a referral note should be filled, handed to the client and she should be explained on where to go for further management

The health worker should refer a client/patient to health facility that is able to handle the types of obstetric condition identified to avoid wastages of time and transport costs encountered by the patient/family. The health worker with assistance of relatives should organize quick means of transport. A relative/health worker escorts the mother where applicable.

Conducting Follow up Visits for Pregnant Women

Purpose

Monitor progress of pregnancy and the well-being of the mother and foetus
Identify and manage arising conditions such as STIs or HIV risk, pre-eclampsia, anemia, syphilis
Provide information on planning to delivery, preparing for the newborn, postpartum care and family planning
Get opportunity to deal with the woman‘s‘ concerns

Frequency of Follow-Up Visits

Routine

More frequently if the mother has recurrent risk factor
Every 4 weeks until 30 weeks
Then every 2 weeks until 36 weeks
And then every week until delivery

More frequently if the client has risk factors (past or present such as:

– Vaginal bleeding during pregnancy late
– Unsure of dates and booked
– Past history pre-eclampsia, premature labour, small or large gestation
– Not gaining weight or fundal height not growing
– Gaining weight exclusively

Antenatal Care in Reproductive Health Read More »

DELAYS IN SAFE MOTHERHOOD

DELAYS IN SAFE MOTHERHOOD MEANS DEATH

Many women die due to delay at several levels while seeking medical help. The community and health workers must work hand in hand to prevent this delay and addressing this problem will reduce maternal death and promote safe motherhood.

Some causes of delay in acquiring medical care

Delay in decision making.

✔ Lack of information on health services available
✔ Communication barrier in language or bad roads and physical barriers like lakes or mountains
✔ Lack of resources e.g. no money or husbands is away and transport cannot be got to transport mother to the hospital
✔ Inappropriate care e.g. mother taken to TBAs first
✔ Lack of decision making by the mother since she is waiting for the husband to come back to give her permission and money.

Delay in reaching the health facility

✔ Distance may delay the mother so that by the time she reaches the hospital is too late
✔ Transport may not be available to take mother quickly to hospital
✔ Road may be bad and impossible taking a longer time to reach hospital
✔ Cost of transport may be too high for the mother

Delay in receiving adequate care

✔ Unskilled staffs who lack knowledge on what to do for the mothers and dealing with high risk pregnancy
✔ Drugs may not be available in the health units, this includes blood for transfusion, antibiotics, analgesics, etc
✔ Lack of equipment e.g. sterile supplies which may delay cesarean section or syringes which may delay giving an oxytocic drugs
✔ Few varieties of services offered at the health facilities.

Factors that affect delay to seek medical care

Family – mother may be single or young and does not know whether she is pregnant or fears to go to health unit – mothers may wait for a decision to be made by the husband who may be away – mother -in- law may delay as she tries to manage giving herbs for contraction
Husband – she may take time to decide or may be away looking for money
Education level – if lowly educated, mother may not think of seeking the advice
Socio-economic status – poverty may prevent quick action
Natural barriers – like rivers, likes, mountains and floods
Security; wars and insurgencies

Maternal Mortality

This is the death of a woman/mother while pregnant or within 42 days of the termination of pregnancy irrespective of the duration and the sites of pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Maternal mortality rate

This is the ratio of the total number of maternal deaths occurring in a period of time (usually a year) to the total number of live births occurring in the same period expressed as a percentage (or per 1,000 or 100,000).

Incidence

Worldwide, every year approximately 8 million women suffer from pregnancy related complications. Over half a million of them die as a result. The problem of maternal mortality and morbidity are greatest (99%) for the poor women in the developing countries. One woman of 11 may die of pregnancy related complications in developing countries compared to one in 5000 in developed countries. It is further estimated that for 1 maternal death at least 16 more suffer from severe morbidities.

The maternal mortality rate in Uganda has been declining over the years, from 506/100,000 in 2004 to 435/100,000 in 2011. However, this is one of the highest in the world and demands for more concerted efforts towards its reactions. The new report released by the World health organization (WHO) has shown a remarkable decrease in maternal mortality by 44% worldwide due to fully implemented millennium development goals. However, there is not much difference in the reduction in the developing countries like Uganda.

Factors contributing to the high maternal mortality in Uganda

There is no single factor that can be counted on as responsible for the high maternal mortality in Uganda. It is rather an interplay of factors. Any approach therefore, aimed at effectively addressing maternal mortality has to pay a close look at all those factors. The easily identifiable ones in Uganda include the following:

Poverty

Several women are engaged in productive work at home and do not have means of earnings. Such women cannot afford to meet even simple costs like transport in case any emergencies develop. Poverty also means that the woman will not be able to afford basic human needs like food which will predispose the woman to further complications during pregnancy and/or labour. They are also likely to be less privileged in the fields of nutrition, housing, education and antenatal care.

Gender issue

In Uganda, men are decision makers on all matters in the home including health care seeking. This means that the woman may have to wait for the man to grant her permission in order to seek medical care. Some women are even prevented from attending antenatal care by their husbands. This predisposes the mother to developing complications in the absence of a trained health worker who can offer help.

Inadequate and inaccessible health services

There are very few health facilities equipped to handle and manage conditions associated with pregnancy and delivery. Despite government policy of bringing services close to the people, some women need to travel long distances in order to access a health facility. This usually keeps those who feel unwell away as they may not be in position to walk or have the money for transport.

Limited health workers

The number of trained health workers in Uganda is still very low compared with the skyrocketing population. This has resulted in long queues observed daily at the various rural and urban health facilities as clients wait to be attended to. Unfortunately others go back without attention. This discourages many and at the end, women prefer to be

attended to by the village traditional healer or herbalist who may not have the necessary skills to manage incase complications develop.

Poor attitudes of health workers towards mothers.

On many occasions, health workers have been reported of being rude, arrogant and unfriendly while attending pregnant women and those in labour. This scares such women away and finally ends up in the hands of untrained people for help. Health workers need to develop better attitudes and make the caring environment friendly so as to motivate mothers to seek health services from them.

Early marriages

For a long, the girl child has been seen as a source of wealth for the family. Girls are forced into marriages at a tender age for the family to acquire cattle and money. These girls get pregnant before their bones and bodies are fully developed which predisposes them to various complications during pregnancy and/or labour.

Illiteracy

Women, over the years, have comprised the highest number of those who cannot read and write. This means that they cannot effectively influence policy on matters that affect them like reproductive health. As such, they surrender all rights of decision making to the men

including the number of children to have and sometimes the age of marriage. Education keeps girls in school until they are old enough to marry and have children. It also empowers them to stand out for their rights and freedom.

Beliefs, customs and taboos(harmful traditional practices)

Some traditional customs, beliefs and taboos predispose women to developing complications during pregnancy or labour. Denying women some nutritious foods like chicken, eggs etc. predispose them to malnutrition which in turn has a negative bearing to reproductive life. Practices like female genital mutilation predispose the woman to extensive perineal tears that may lead to excessive hemorrhage during child birth and yet the use of some traditional herbs (Cytoxic herbs) may predispose to uterine rupture. Some communities perceive women who deliver from health units as not strong being enough. This is dangerous as it predisposes any woman to unnecessary complications during labour.

Poor transport and communication infrastructures

Statistically, seventy five percent (75%) of the Ugandan population lives in rural areas and yet most of the health facilities are located in urban centers. The road network linking up these areas are very poor in most of the areas which delay transfer of women in case complications develop during pregnancy or labour. This is more common in geographically impassible areas like mountainous parts of Kigezi, areas encircled by water bodies.

High child mortality

Uganda‘s child mortality is still high though it has been declining over the years. Parents are filled with uncertainties as to how many of their children will make it to adulthood. As such, they prefer to produce many for a few to survive. For example, in post war Northern Uganda, many people claim that they have lost their relatives more than expected in the war and so the need to produce more children is valued currently.

Desire for more children

Many people perceive children as a source of prestige in the community. A family with many children was always looked at as being very strong and secure and as a result, many people desire to have many children and yet more children mean more deliveries and moiré risk for maternal mortality.

Sex preferences in children

Some women may keep on giving birth in an attempt to get a child of their preferred sex. Parents tend to rate children of different children sex differently as a result may prefer a particular sex. This is risky to the mother who carries and delivers the pregnancy and also unhealthy to the father and children due to inadequate care that will be provided and received.

High fertility rate

Uganda has a very high fertility rate estimated at about 7 children per woman per reproductive life span. It is one of the highest in the world. This implies that women are exposed to the risks many times.

Underutilization of the existing services
Inadequate drug supplies and other medical related equipment is most often interrelated and are responsible for an increased number of avoidable deaths. Poor referral systems for handling emergency
Poor attitudes by the health workers
Noninvolvement of the husbands
Lack of awareness/ignorance
Disrespect for human rights
Gender stereotypes and inequalities

Delays that can lead to maternal mortality

In most instances, women who die in childbirth experienced at least one of the following delays:

1. Delays at the individual woman‘s levels

– Inability to make decision on life threatening health conditions in time for appropriate response
– Late recognition that there is a problem,
– Fear of the hospital or of the costs that will be incurred there,

Delay at the level of the family and community levels in decision making to assist the woman to more/husband‘s issues/ in laws‘ issues.
Delay at the level of accessing services. Usually transport is a major problem and or lack of resources. Many villages has very limited transportation options and poor roads.
Delay in the health units to institute the necessary interventions.

– Inadequate skills and poor staffing
– Failure to make appropriate decision
– Lack of drug supplies etc.

Note: Not only mothers die, babies too die. 4000,000 newborn deaths occur globally yet almost all are due to preventable conditions.

Causes of maternal mortality

There are several causes of maternal mortality broadly grouped into direct and indirect causes. In Uganda 506 per 100,000 women die of pregnancy and birth related and recent data shows that 16 women die every day during giving birth related complications in Uganda.

A direct death is one resulting from obstetric complications of pregnancy, delivery or from interventions, omissions or incorrect treatment or a chain of events resulting from the above.

An indirect death is one resulting from a previously existing diseases (present before) or developed during pregnancy and was not due to obstetric causes but aggravated by the physiological effects of pregnancy.

Direct Causes of Maternal Mortality

i) Sepsis

This is a common cause of maternal mortality. All women get infections when membranes rupture early, delivered in dirty environments like gardens or following operative procedures where the aseptic technique was compromised. All women should be given prophylactic antibiotics following cesarean section. Women who had prolonged labour or early rupture of membranes should be given antibiotics. If such a woman develops fever, she should be carefully assessed, admitted and appropriate treatment instituted as soon as possible.

ii) Hemorrhage

This is a serious condition especially in women with underlying anemia or bleeding disorders. It may present as APH due to placental retention, uterine inertia etc. women should be encouraged and given micronutrient supplements during pregnancy, screened for anemia and always book some units of blood for mothers in labour.

iii) Early pregnancy deaths

This is death resulting from ectopic pregnancies and abortions. This is one of the major causes of maternal mortality in Uganda. Criminal abortions account for the highest number of deaths in this category.

iv) Hypertensive conditions

Severe pre-eclampsia and eclampsia are common causes of maternal mortality. If any mother develops any of these complications should be managed effectively. Magnesium sulphate is the drug of choice. Ensure proper fluid management. Always identify any risk factors of developing pre-eclampsia in a mother during antenatal care and manage them promptly and effectively whenever possible.

v) Others

– Thrombosis and thrombo-embolism
– Genital trauma

Indirect causes of maternal mortality

i) Cardiovascular diseases

– Pulmonary hypertension
– Endocarditis

ii) HIV/AIDs

iii) Malnutrition

iv) Diabetes
v) Thyroid diseases
vi) Anemia

Predisposing factors to maternal mortality and morbidity

∙ Early pregnancy (less than 20 years old);
∙ Uncontrolled fertility;
∙ Low socioeconomic status of women;
∙ Poverty and lack of empowerment of women;
∙ Lack of access to quality services;
∙ Inadequate referral systems;
∙ Lack of support from spouses.

Prevention of maternal mortality

Eighty percent (80%) of these deaths can be prevented through actions that are effective and available in developing country‘s settings. This is a coordinated long term effort within the families, countries and health systems, national legislation and policy.

Primary prevention

Girl child education

Education keeps girls at school until they are old enough to marry and have children. This means that they get fewer pregnancies and produce fewer babies. Educated women will also have more chances of getting employed and have money to look after themselves better. Education also empowers them to stand out for their rights and freedom.

Proper nutrition of the girl child

Malnutrition during childhood and puberty has been closely related to the inadequate development of the pelvis (contracted). This usually predisposes the woman to developing obstetric complications like Cephalopelvic disproportion (CPD). Parents should be educated that girl children need more to eat as much as boys and adolescent girls should be encouraged to eat adequate food for proper body development and functioning.

Family planning

Maternal mortality is common in women who get pregnant while too young (below 20 years of age). Most cases of criminal abortion that turns out with complications are as a result of unwanted pregnancies. Family planning provides an absolute answer to all these questions by enabling the mother (couple) to have children by chop ice and not by chance.

Quality antenatal care

All pregnant women should be encouraged to have timely attendance of at least 4 quality antenatal visits, where the woman is fully assessed for presence of any risk factors that may predispose her to developing complications. Once any risk factor has been identified, it should be managed effectively and appropriately during antenatal care.

Immunization

All women in the reproductive age should be immunized against tetanus, HepB. This is because; such women are at higher risk of developing the infections during any time in the reproductive cycle.

Provision of information, education and communication about maternal mortality. Individuals and families should be given adequate information about the causes of maternal mortality and how they can be prevented. It is important that such messages spell out the roles of each individual in preventing maternal mortality. Individuals should be empowered to take action and stop thinking that the sole role of government is to protect and care for their lives.

Secondary prevention

A skilled attendant should be present at every birth. Functional referral systems is very essential here
Emergency obstetric care services are to be provided and made accessible to the people
Transport and communication networks need to be improved to gain access to all health facilities. Transport means like ambulances should be made available and accessible.
Health facilities should be equipped with adequate equipment, operating theaters which should be functional, blood storage facilities in case of any emergency, equipment in good working conditions and drugs. The government should always ensure a steady supply of essential drugs.
Adequate referral systems for complications should be instituted. Clients should be in position to get assistance from a higher level in the shortest time possible. Some clients decline referrals because they are not sure of obtaining any better help at the next level. In most cases, such clients either refuse and stay at the referring health units or go home and wait for whatever may happen next.
Proper evaluation and reporting of maternal deaths and timely intervention taken
Decentralization of services to make them available to all women
Barriers to the access to health care facilities should be removed; policies should increase women‘s decision making power as regards to their own health and reproduction.
Recruitment of skilled staffs to balance of the workload
Improving the standard and quality of care by organizing refresher courses for the health care personnel.

Tertiary prevention

This involves the control and management of complications that may arise
Emergency obstetric care services should be provided.

Maternal Morbidity

Although considerable attention has been given to maternal mortality, very little concern has been expressed for maternal morbidity. It is estimated that for one maternal death at least 15 more suffer from severe morbidities. As such about an optimistic 5-7 million suffer a severe impaired quality of life as a result of short term or long term disability.

Definitions

Obstetric morbidity originates from any cause related to pregnancy or its management any time during antepartum, intrapartum and postpartum period, usually up to 42 days ( weeks) after confinement.

Parameters of Maternal Morbidity

✔ Fever more than 38 degree centigrade
✔ Blood pressure greater than 140/90mmHg
✔ Recurrent vaginal bleeding
✔ Hb less than 10.5g/dl irrespective of gestational age
✔ Asymptomatic bacteriuria of pregnancy

Classifications

i) Direct obstetric morbidity

– Temporary
– Permanent

ii) Indirect obstetric morbidity

Direct

∙ Temporary (mild)

– APH, PPH, eclampsia, obstructed labour
– Rupture uterus
– Sepsis
– Ectopic pregnancy
– Molar pregnancy etc.

∙ Permanent (chronic)

– Vesico-vaginal fistula and rectovaginal fistula
– Dyspareunia
– Prolaps
– Secondary infertility
– Obstetric palsy

Indirect

These conditions are only expressions of aggravated previous existing diseases like malaria, hepatitis, tuberculosis, anemia etc. by changes in the various systems during pregnancy.

Perinatal Mortality

This is defined as deaths among fetuses weighing 1000 g or more at birth (greater than 28 weeks gestation) that die before or during delivery or within the first 7 days of delivery. The Perinatal mortality rate is expressed in terms of such deaths per 1000 total births. The Perinatal mortality rate closely reflects both the standards of medical care and effectiveness of public and social health measures. According to WHO, the limit of viability is brought to a fetus weighing 500g (22 weeks).

Incidence

∙ Worldwide nearly 4 million newborns die within the first week of life and another 3 million are born dead.
∙ Perinatal deaths could be reduced by at least 50% worldwide if key interventions are applied for the newborn.
∙ Perinatal mortality is less than 10 per 1000 total births in the developed countries while in the developing it is much higher.
∙ The major health problem in the developing world arise from the synergistic effects of malnutrition, infections and unregulated fertility combined with lack of adequate obstetric care
∙ Majority of feotal deaths (70-90%) occur before the onset of labour. The important causes.

Predisposing factors to perinatal mortality

Many factors influence the perinatal mortality in Uganda and theses are briefly discussed below;

Maternal factors

a) Epidemiology

– Age over 35 years
– Teenage pregnancies
– Multiparity
– Low socio economic condition(poverty)
– Poor maternal nutritional status

Note. All the above adversely affect the pregnancy outcome

b) Medical disorders

– Anemia (Hb less than 8g/dl)
– Hypertensive disorders
– Syphilis
– Diabetic mellitus
– Prematurity
– Congenital malformation (baby)
– Malaria
– Other infections

c) Obstetric complications

– Antepartum hemorrhage (APH) particularly abruptio placentae is
responsible for about 10% of perinatal death due to severe hypoxia
– Pre-eclampsia, eclampsia is associated with high perinatal loss either due to placental insufficiency of prematurity
– Rhesus Iso-immunization
– Cervical incompetence which may lead to premature effacement and
dilatation of cervix between 24-36 weeks

d) Complications of Labour

– Dystocia from disproportion, mal-presentation and abnormal uterine action
– Premature rupture of membranes (PROM) may result in hypoxia, amnionitis and birth injuries contributing to perinatal death

Feto-placental factors (causes)

– Multiple pregnancy, most often leads to preterm delivery and usual complications
– Congenital malformation and chromosomal abnormalities are responsible for 15% of perinatal death
– Intrauterine growth restriction and low birth weight babies

Unexplained causes

About 20% of stillbirths have no obvious fetal, placental, maternal or obstetric causes.

4. Other causes/risk factors refer to maternal mortality

Causes of perinatal mortality

Infection

– Sepsis
– Meningitis
– Pneumonia
– Neonatal tetanus, congenital

Birth asphyxia and trauma

Hypothermia

Prematurity and/ low birth weight
Congenital malformation

Control and prevention of perinatal mortality

As every mother has a right to conclude her pregnancy safely, so also the baby has a right to be born alive, safe and healthy. As such improvement of obstetric services will not minimize perinatal death appreciably therefore simultaneously demographic and social changes help in the reduction of perinatal mortality rate significantly. The following measures are helpful in reducing perinatal mortality.

Pre pregnancy health care and counseling
Genetic counseling in high risk cases and prenatal diagnosis to detect genetic, chromosomal or structural abnormalities are essential
Regular antenatal care with advice regarding health, diet and rest
Detection and early management of medical disorders in pregnancy such as anemia, diabetes, hypertension
Screening of high risk clients where mandatory hospital delivery is instituted like those from poor socioeconomic status, high parity, extreme of age etc.
Careful monitoring and management of Labour to detect hypoxia, early evidence of traumatic vaginal delivery etc.
Skilled birth attendance to minimize sepsis
Provision of neonatal referral services especially to look after the preterm babies
Health education of the mothers about the care of a new born such as early exclusive breastfeeding and prevention of hypothermia
Educating the community to utilize family planning services and also to utilize the available maternity and child health care services
Increased resource allocation towards maternal and child health services
Regular review of perinatal death cases and ensuring effective supervision, monitoring and evaluation to realize the missing gaps
Improving on social infrastructures like health care, transport and communication network
Continuous decentralization of maternal and child health care services

Preconception Care

The outcome of pregnancy depends so much on the factors that operate during the period of growth and development of the mother from childhood. Some of the factors which influence proper growth and development of the mother are;

– type of birth and circumstances surrounding her birth
– her birth weight
– breast feeding and nutrition
– childhood infections
– formal education
– sexual and reproductive health education and services utilization
– Socio-cultural practices

Therefore it is important that the girl child is given adequate care during this period of development.

Pre-conception refers to the care of women and men during their reproductive years, which are the years they can have a child. It focuses on taking steps now to protect the health of a baby they might have sometimes in the future.

However all women and men can benefit from preconception care, whether or not they plan to have a baby one day. This is because part of preconception health is about people getting and staying healthy overall, throughout their lives. In addition, no one expects an unplanned pregnancy. But it happens often.

Preconception care is the medical care a woman or man receives from trained medical professionals that focus on the parts of health that have been shown to increase the chance of having a healthy baby.

Preconception health is important for every woman, not just those planning pregnancy. It means taking every woman, not just those choosing healthy habits. It means living well, being healthy and feeling good about your life. Preconception care is about making plans for the future and taking the steps to get there.

Preconception care is important for men too. It means choosing to get and stay as healthy as possible and helping others to do the same as well. As a partner it means encouraging and supporting the health of your partner. As a father, it means protecting your children.

Healthy babies

Preconception care is a precious gift to babies. For babies it means their parents took steps to get healthy before pregnancy. Such babies are less likely to be born early (preterm) or have a low birth weight; they are likely to be born without birth defects or other disturbing conditions. Preconception care gives babies the best gift of all the best chance for a healthy start in life.

Healthy families

Ensuring preconception health is a great way to create a healthy family. The health of a family relies on the health of the people in the family. Taking care of your health now will help to ensure a better quality of life for yourself and your family in the coming year.

Objective

Assess clients‘ readiness for pregnancy by ensuring adequate mental, physical and socio economic readiness.
Prevent, treat and manage medical conditions that affect pregnancy and the newborn. 3. Prepare for pregnancy and childbirth
Promote safer and responsible sexual behaviors
Promote delay of age at first pregnancy
Prevention of HIV and sexually transmitted disease

Services offered during Preconception Care

Education and information on:

– Sexuality
– Growth and development of the coming child
– Pregnancy and child birth
– Responsible parenthood
– Family planning
– STI/HIV
– Malaria prevention
– Personal hygiene
– Nutrition
– Use of drug during pregnancy (drugs of abuse and medicine )
– Previous health intervention – repair of Vesico-vaginal fistula, ruptured uterus, treatment for infertility etc.
– Diabetes mellitus

Screening for and managing conditions which may complicate pregnancy, childbirth and health of the mother and child thereafter e.g.

– HIV
– Syphilis
– Sickle cell diseases – Heart disease
– Hypertension

Provision of services

– Congenital abnormalities – Aneamia
– Diabetes Mellitus
– Mental illness
– Folic acid supplementation 3 months for woman before pregnancy
– Immunization
– Deworming for women
– Management of STI/STDS and other identified diseases
– Provision of long other insecticide treated nets
– Routine screening for reproductive health cancers
– Family planning
– VCT for HIV

Support channels.

– Identify and locate the organization that will support the groups and work with them.
– Appropriate counseling of individuals and couples about their pregnancy needs
– Establishing the pre pregnancy health status/profile for the purpose of follow up.
– Identify special group women such as, disabilities, adolescence and HIV infection
– Develop appropriate intervention to address the needs of the different special groups
– Mobilize and sensitize the community to be supportive to the needs of the special groups.

Responsible motherhood and fatherhood
Contraception and family planning information and service.

Where Can Preconception Care be done.

∙ Health units
∙ Community based group.

Ways to reach out to special groups.

∙ Health education in the community
∙ Mass media
∙ Church groups
∙ Appropriate ITC materials
∙ Opinion leaders.

DELAYS IN SAFE MOTHERHOOD Read More »

HAZARD PREVENTION AND CONTROL

HAZARD PREVENTION AND CONTROL

Methods of hazard control/Hierarchy of Controls at the workplace

Considerations for Effective Control and Prevention of Hazards

Prevention of Occupational Health Hazards

Primary Prevention

Secondary Prevention

Tertiary Prevention

Occupational hazard assessment

Importance of Occupational Hazard Assessment.

Methods of Hazard Identification, Prevention, and Control

Steps in Occupational Hazard Assessment and Identification

1. Collect existing information about workplace hazards

2. Inspect the workplace for safety hazards

3. Identify hazards associated with emergency and non-routine situations

4. Characterize the nature of identified hazards, identify interim control measures, and prioritize the hazards for control

Good safety Practices

OCCUPATIONAL HEALTH HAZARDS

OCCUPATIONAL HEALTH HAZARDS

Classification of Workplace Hazards

Physical Hazards

Effects of Physical Hazards on Individuals in the Workplace

Prevention of Physical Hazards

Chemical Hazards

Types of Chemical Hazards.

Effects of Chemical Hazards

Prevention of Chemical Hazards

Precautions for potential exposure to noxious gasses include:

Mechanical Hazards

Effects of Mechanical Hazards

Prevention of Mechanical Hazards

Biological Hazards

Transmission of Biological Hazards

Ergonomic Hazards

Principles of Ergonomics

Causes of Ergonomic Hazards

Effects of Ergonomic Hazards

Prevention of Ergonomic Hazards

Psychosocial Hazards

Types of Psychosocial Hazards

The Epidemiologic Triangle

Occupational Health and Safety

OCCUPATIONAL HEALTH AND SAFETY

Aims/Objectives of Occupational Safety and Health

Principles of Occupational Health and Safety

Components of Occupational Health and Safety in the Workplace

Elements of the work

Ethics in Research

Research Ethics

History of Research ethics

Why study research ethics

Major concerns in research ethics

PLAGIARISM

AUTHORSHIP

RESEARCH MISCONDUCT

General ethical principles

Respect for Persons

Informed Consent

Privacy and Confidentiality

Beneficence

Justice

The Institutional Review Board (IRB)

Gender Based Violence (GBV)

Gender Based Violence (GBV)

Key terms related to Gender-based Violence

Example of gender characteristics

2. Gender-based violence;

3. Violence against women;

4. Sexual violence, exploitation and abuse.

5. Gender equality

6. Gender blind

7. Gender responsiveness

9. Sex

10. Violence

11. Sex typing

12. Gender equity

13. Gender sensitive

14. Gender neutrality

15. Gender roles