13. Declaration on the Elimination of Violence against Women

Background 
Maternal and neonatal morbidities and mortalities have received much attention over the years in sub-Saharan Africa; yet addressing them remains a profound challenge, no more so than in the nation of Ghana. This study focuses on finding explanations to the conditions which lead to maternal and neonatal morbidities and mortalities in rural Ghana, particularly the Upper West Region.


Method 
Mixed methods approach was adopted to investigate the medical and non-medical causes of maternal and neonatal morbidities and mortalities in two rural districts of the Upper West Region of Ghana. Survey questionnaires, in-depth interviews and focus group discussions were employed to collect data from: a) 80 expectant mothers (who were in their second and third trimesters, excluding those in their ninth month), b) 240 community residents and c) 13 healthcare providers (2 district directors of health services, 8 heads of health facilities and 3 nurses).


Result 
Morbidity and mortality during pregnancy is attributed to direct causes such urinary tract infection (48%), hypertensive disorders (4%), mental health conditions (7%), nausea (4%) and indirect related sicknesses such as anaemia (11%), malaria, HIV/AIDS, oedema and hepatitis B (26%). Socioeconomic and cultural factors are identified as significant underlying causes of these complications and to morbidity and mortality during labour and the postnatal period. Birth asphyxia and traditional beliefs and practices were major causes of neonatal deaths.


Conclusion 
These findings provide focused targets and open a window of opportunity for the community-based health services run by Ghana Health Service to intensify health education and promotion programmes directed at reducing risky economic activities and other cultural beliefs and practices affecting maternal and neonatal morbidity and mortality.

/pdf/maternal-health-care-initiatives-causes-of-morbidities-and-1d5r45wwvb.pdf

Maternal health care initiatives: Causes of morbidities and mortalities in two rural districts of Upper West Region, Ghana.

Background Sedation for colonoscopy using intravenous propofol has become standard in many Western countries. Objective Gender-specific differences have been shown for general anaesthesia in dentistry, but no such data existed for gastrointestinal endoscopy. Design A prospective observational study. Setting An academic teaching hospital of Hannover Medical School. Patients A total of 219 patients (108 women and 111 men) scheduled for colonoscopy. Intervention Propofol sedation using electroencephalogram monitoring during a constant level of sedation depth (D0 to D2) performed by trained nurses or physicians after a body-weight-adjusted loading dose. Main outcome measures The primary end-point was the presence of gender-specific differences in awakening time (time from end of sedation to eye-opening and complete orientation); secondary outcome parameters analysed were total dose of propofol, sedation-associated complications (bradycardia, hypotension, hypoxaemia and apnoea), patient cooperation and patient satisfaction. Multivariate analysis was performed to correct confounding factors such as age and BMI. Results Women awakened significantly faster than men, with a time to eye-opening of 7.3 ± 3.7 versus 8.4 ± 3.4 min (P = 0.005) and time until complete orientation of 9.1 ± 3.9 versus 10.4 ± 13.7 min (P = 0.008). The propofol dosage was not significantly different, with some trend towards more propofol per kg body weight in women (3.98 ± 1.81 mg versus 3.72 ± 1.75 mg, P = 0.232). Conclusion The effect of gender aspects should be considered when propofol is used as sedation for gastrointestinal endoscopy. That includes adequate dosing for women as well as caution regarding potential overdosing of male patients. Trial registration ClinicalTrials.gov (Identifier: NCT02687568).

Women awaken faster than men after electroencephalogram-monitored propofol sedation for colonoscopy: A prospective observational study.

Genital ambiguity, is defined as a group of congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical. It constitutes a major social emergency and the decision making in relation to sex assignment has been perceived as an extremely disturbing and difficult to both families and health care professionals. It can also be a medical emergency as it may lead to life-threatening adrenal crisis. Each patient should be evaluated individually by a well-coordinated experienced multidisciplinary team of specialists in a higher center capable of managing such disorders. The team should include a geneticist, neonatologist, endocrinologist, pediatric surgeon, urologist, psychiatrist and psychologist, a social worker, and other specialists such as a nurse, and gynecologist to be consulted whenever needed. The estimated incidence was found to be approximately 0.1% to 0.2% worldwide i.e, 1:4500-5000 live birth. The 46XX is the most common cause, while the majority of these patients congenital adrenal hyperplasia (CAH) is the most underlying aetiology. The 46XY DSD is a heterogeneous disorders that often result from a disruption in the production or response to testosterone, dihydrotestosterone, or Mullerian inhibitory substances. Chromosomal DSD includes condition resulting from abnormal meiosis, including Klinefelter syndrome (47XXY) and Turner syndrome. The evaluation of patients with sex disorders requires a through history, physical examination, karyotype, serum electrolytes, and specific hormones, such as 17-OH-progesterone.The pediatric radiologist has a major role in diagnosis. In Saudi Arabia, a general guidelines were suggested by the council of senior ulama to manage patients with DSD in accordance with the islamic laws. This should be the practice in other muslim countries. Health professionals need to be aware of the existence of such recommendation for a better care of patients.

Gender assignment in disorders of sex: An Islamic perspective from Saudi Arabia

Objective: To monitor the prevalence of risk factors for the onset of noncommunicable diseases in adults from a municipality in Northern Parana, Brazil. Methods: This is a crosssectional population-based study conducted in 2013 through home interviews with 453 adults selected according to the demographic extension areas of the municipality. The variables studied were those related to sociodemographic conditions and main risk factors associated with chronic diseases such as smoking, physical activity, alcohol consumption and nutritional status. Bivariate analysis of variables was performed at each level of measurement using P-value <0.05. Results: There was an association between risk factors for noncommunicable diseases and sociodemographic characteristics such as gender, education and marital status (p <0.05). The proportion of physical inactivity was found in women, individuals with low education and widowed people. Regarding the abusive consumption of alcohol, men, individuals with low education and single people presented statistical significance. Smoking was prevalent among men and single individuals and excessive weight was prevalent among men, individuals with low education and married people, with statistical significance for these variables. Conclusion: The sociodemographic characteristics showed an association between the main risk factors for NCDs, corroborating the hypothesis that these diseases may also have their origin in the social determinants.

/pdf/monitoramento-de-fatores-de-risco-para-doencas-cronicas-nao-2vsj6wag6b.pdf

Monitoramento de fatores de risco para doenças crônicas não transmissíveis: um estudo de base populacional

Male births exceed female births by 5–6% (for a sex ratio at birth of 1.05–1.06) while a women's life expectancy, on a global scale, is about 6 years longer. Thus within various age groups the male:female ratio changes over time. Until age 50 years men outnumber women; thereafter their numbers show a sharp decline. Consequently at age 80 years, there are many more women than men. An estimated 25% of this male excess mortality is due to biological causes, the rest being explained by behavioural, cultural and environmental factors. For both women and men, the main health risks related to lifestyle are smoking, alcohol, unhealthy diet and physical inactivity. In the year 2010, overweight (BMI: 25–29 kg/m2) and obesity (BMI: >30 kg/m2) were responsible for over 3 million deaths, with similar relative risks in men and women for overweight and obesity. Smoking and alcohol are the major causes of the global gender gap in mortality. For women in some parts of the world however pregnancy is also hazardous. On a global scale, in 2013 about 300 000 deaths were related to pregnancy, with sub-Saharan Africa registering the highest maternal mortality: over 500 maternal deaths per 100 000 births. Additional woman's health risks arise from gender discrimination, including sex-selective abortion, violence against women and early child marriage. Providers should be aware of the effect that these risks can have on both reproductive and general health.

/pdf/the-influence-of-social-factors-on-gender-health-h5g1r4tktr.pdf

The influence of social factors on gender health

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The influence of social factors on gender health