obstetric fistula kashmir shiekh who 2007

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27 March 200727 March 2007 MustafaMustafa 11

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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obstetric fistula kashmir shiekh who 2007

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