Download - Obstetric Fistula Kashmir Shiekh WHO 2007
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Prevalence of Obstetric fistula inPrevalence of Obstetric fistula inKashmirKashmir--IndiaIndia
Dr. G.H. MustafaDr. G.H. Mustafa ShiekhShiekh, M.D., M.D.GovernmentGovernment Medical College associatedMedical College associated LalaLala DedDed
HospitalHospital SrinagerSrinager--KashmirKashmir--IndiaIndia
SociSocittMMdicaledicaleBeaulieu andBeaulieu andCHILDREN of KashmirCHILDREN of Kashmir
ScholarshipScholarship
Training Course in Reproductive Health ResearchTraining Course in Reproductive Health ResearchWHO 2007WHO 2007
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IntroductionIntroduction
DefinitionDefinition Tissue destructionTissue destruction
Tissue lacerationTissue laceration TypesTypes
VesicovaginalVesicovaginal fistulafistula
RectovaginalRectovaginal fistulafistula
ClassificationClassification SimpleSimple
complexcomplex
E.S.E.S. RovasnaRovasna20012001
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HistoryHistory
4000 B.C first fistula recorded.4000 B.C first fistula recorded.
Persian physicianPersian physicianAvenicaAvenicain 11th centuryin 11th century
obstructed labour obstetric fistulaobstructed labour obstetric fistula
Dr.JohnDr.JohnPeterPeterMathauerMathauerof Virginia in 1838of Virginia in 1838successfully closedsuccessfully closedvesicovaginalvesicovaginalfistula usingfistula usingwire sutures.wire sutures.
Dr.J.MarisonDr.J.MarisonSims of America in 1845Sims of America in 1845
first fistula case and on 30th operation on the samefirst fistula case and on 30th operation on the samepatient successfully closed the fistulapatient successfully closed the fistula
**Father of AmericanFather of AmericanGynecologyGynecology**
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Demography of Jammu and KashmirDemography of Jammu and Kashmir An Indian stateAn Indian state
Area of 222236Area of 222236sq.kmssq.kms
Altitude..Altitude..
17301730--2840mtr2840mtr BordedBordedbyby
SouthSouth -- HimachalHimachal PradeshPradesh
WestWest -- PakistanPakistan
North and EastNorth and East -- ChinaChina
Population..Population.. 10 million10 million
FemalesFemales -- 4.8 million4.8 million
Overall Literacy rate of 43%Overall Literacy rate of 43%
Disturbed area since 18 yearsDisturbed area since 18 years
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MethodologyMethodology
Retrospective studyRetrospective study
descriptive observationaldescriptive observational
Qualitative and quantitative methodsQualitative and quantitative methods
will be used to collect datawill be used to collect data Qualitative studyQualitative study
Focus group discussion and inFocus group discussion and in--depthdepthinterviewsinterviews
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Quantitative studyQuantitative study
Quantitative study will be done inQuantitative study will be done in
hospitals and communityhospitals and community In the community survey local doctors,In the community survey local doctors,
nurses, midwives, traditional birthnurses, midwives, traditional birthattendants and NGOs (if any) will beattendants and NGOs (if any) will be
involvedinvolved
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QuestionnaireQuestionnaire
Questionnaire has never been included inQuestionnaire has never been included inStandardized Demographic Health SurveyStandardized Demographic Health Survey
Questions to be asked:Questions to be asked: residence of womenresidence of women
ageage
parityparity
occupationoccupation educationeducation
ante natal check upante natal check up
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Data for index pregnancyData for index pregnancy
Duration of labourDuration of labourhours/dayshours/days
Place of deliveryPlace of delivery.home/hospital.home/hospital Type of deliveryType of deliveryvaginal/abdominalvaginal/abdominal
if vaginalif vaginal.spontaneous/vacuum/forceps.spontaneous/vacuum/forceps
Presence of birth attendantPresence of birth attendant.yes/no.yes/no Circumstances leading to delayed referralCircumstances leading to delayed referral
Pregnancy outcomePregnancy outcome....perinatalperinataldeath/rupturedeath/ruptureuterusuterus
Any harmful traditional practiceAny harmful traditional practice.(.(gishirigishiricuts)cuts)
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Regarding fistulaRegarding fistuladuration of fistuladuration of fistula..(years)..(years)previous fistula surgeryprevious fistula surgery.yes/no.yes/no
Other questionsOther questionsmensesmensesyes/noyes/nopain during walkingpain during walkingyes/noyes/nopain during coitus (if any)pain during coitus (if any)...yes/no...yes/no*social consequences*social consequences
still married/rejected/widowstill married/rejected/widow
Examination: To confirm the diagnosisExamination: To confirm the diagnosis
General physical examinationGeneral physical examination
Local examinationLocal examination
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Research settingResearch setting
1.Three hospitals1.Three hospitals
LalaLala DedDed hospitalhospital SrinagarSrinagar, Kashmir, Kashmir
Institute of Medical ScienceInstitute of Medical Science SouraSoura
District hospitalDistrict hospital KargilKargil (rural referral hospital)(rural referral hospital)
2.Three districts:2.Three districts:
DistrictDistrict BaramullaBaramulla
DistrictDistrict KupwaraKupwara
DistrictDistrict DodaDoda..
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In hospital study 5 years (2002In hospital study 5 years (2002--2006) records2006) recordswill be checkedwill be checked
--records departmentrecords department--theatre recordstheatre records
--surgeons recordssurgeons records
Regarding number of fistulaRegarding number of fistula
--cases diagnosedcases diagnosed
--cases operatedcases operated--cases referredcases referred
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Schedule of surveySchedule of survey
MonthMonth DateDate PlacePlace
11--1414 LalaLalaDedDedhospitalhospital
2323--2626 DistDistKupwaraKupwara
33--1010 I.M.SI.M.S
1717--2121 BarmullaBarmullaDistrictDistrict
55--1515 LalaLalaDedDedhospitalhospital
1818--2121 DistrictDistrictDodaDoda
2626--3030 DistDist.. HospitalHospitalKargilKargil
77--1010 DistDist.. KupwaraKupwara1515--2525 LalaLalaDedDedhospitalhospital
2727--3030 BarmullaBarmullaDistrictDistrict
AugAug
JulyJuly
JuneJune
MayMay
I.M.SI.M.S2525--2727
DistDist.. KupwaraKupwara1515--2020
DistrictDistrictDodaDoda55--1010Nov.Nov.
DistDist.. HospitalHospital
KargilKargil2121--2525
BarmullaBarmullaDistrictDistrict
1111--1515
LalaLalaDedDed
hospitalhospital11--77OCtOCt
DistrictDistrictDodaDoda1111--1515
I.M.SI.M.S22--55Sept.Sept.
PlacePlaceDateDateMonthMonth
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DecemberDecember--data compilationdata compilation
--data analysisdata analysis
--dissemination of preliminary reportdissemination of preliminary report
--public presentation of findingspublic presentation of findings
JanuaryJanuary--final report distributionfinal report distribution
--manual developmentmanual development
--final report and recommendationsfinal report and recommendations
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