Community Nursing Hat 1 Essay Example for Free

Community Nursing Hat 1 Essay I chose as my community El Dorado County in the foothills of Northern California. I live in this community. We are a very healthy and active community with a large retirement group. I will go through the four assessments next. The Population Economic Status Assessment shows our population to be around 181,000. We are made up of 80% white Christian, with the next largest ethnic group being about 15% Mexican. The average household income is around $70,000 with 7.9% of people being at or below the poverty level. The Mexican population makes up the biggest percentage of the poor. El Dorado County’s median household income has been higher than the state average since 2000, indicating that its residents have more spending power than the average Californian (El Dorado Co). The unemployment rate is 11.8%. El Dorado County’s unemployment rate has been consistently lower than the California average since 1990. At any given time, there are 600+ homeless people in this community. Around 9000 people receive food stamps another 3000 receive cash aid. On an average, we have much fewer people on public assistance than the national average. According to the information I gathered in the Cultural Assessment Tool, the population in this community has slightly more females than males which is very typical in these rural areas. There are 80% white people living here with about a 15% Mexican population (El Dorado Co). 27% of the populous are affiliated with a church, mostly Catholic Christian, compared to the 50% in the USA (Religions). About 85% of the people are covered by health insurance, which is very high compared to the rest of California. Cancer is the leading cause of death, with heart disease being second. The birth rate is 10.1 per 1000. County birth rates are consistently below average compared to the state, which is attributed to the higher senior population of the county (El Dorado Co). There is a high prevalence of drug and alcohol abuse in this community, related to poor or ineffective coping skills in the populous. There is a  real powerful stigma against the homeless community here, which really could benefit from some community teaching and outreach. The Neighborhood Community Safety Assessment shows that the air and water quality is very good in this community. Carbon monoxide levels are below the US average. They do usually have a few bad air days a year due to fires. There is some residual mercury left over from the mining days, but in low levels (El Dorado Co). During the winter snow, flooding and the cold pose health hazards. During the summer, fires are a hazard to public safety. However, there is excellent fire and police response here in this community. Many rivers and lakes in this community pose a risk for drowning; however, there are very few documented drowning’s here per year. There is quite a bit of poison oak ivy here, and grass and hay fever irritants. Last, I will discuss the Disaster Assessment Planning in this community. Through my research, I found that this community does follow federal guidelines for disaster management (OES). There is a County Operational Area Emergency Operations Plan that was adopted in 2007 (City of Placerville). This plan has four parts that cover administrative, an emergency operations center plan, a recovery plan, plans specific to a type of emergency (terrorism, multi-casualty incidents, hazard mitigation plan, etc.). This plan meets needs for rescue, medical care, food, shelter, clothing, temporary housing, and employment should an emergency arise. This community also uses the CDC’s Public Health Emergency Response Guide for emergency preparedness response. I found all this information on line, but it took considerable research and was not easy. In my research, I found that most residents in this community are not aware of any disaster preparedness plan, nor do they know where to find one. There needs to some community wide teaching on disaster preparedness, and where to find information regarding this. The following is my community genogram and diagnosis. Community Diagnosis Within the parameters assessed above, El Dorado County California is a healthy community. The areas that need improvements are discovering a way to help people respond in healthy ways to painful life events other than drugs alcohol, to create implement a plan to help the homeless community, to educate the public regarding the causes and preventative  measures for Cancer Coronary Artery Disease, and to educate the public regarding emergency disaster preparedness through community outreach programs. Community Diagnosis Within the parameters assessed above, El Dorado County California is a healthy community. The areas that need improvements are discovering a way to help people respond in healthy ways to painful life events other than drugs alcohol, to create implement a plan to help the homeless community, to educate the public regarding the causes and preventative measures for Cancer Coronary Artery Disease, and to educate the public regarding emergency disaster preparedness through community outreach programs. El Dorado County, California hhhh El Dorado County, California hhhh Population Economic Status Located in Northern California Population 181,058 Mostly white Next largest ethnic group Mexican Median household income 70,000 7.9% households at or below poverty level 11.8% unemployment rate 600+ homeless 9,000 receive food stamps 3,000 families receive cash aid Population Economic Status Located in Northern California Population 181,058 Mostly white Next largest ethnic group Mexican Median household income 70,000 7.9% households at or below poverty level 11.8% unemployment rate 600+ homeless 9,000 receive food stamps 3,000 families receive cash aid Cultural Assessment Slightly more females than males Mostly white Christians Subcultures small Mexican Asian Many know how to achieve good health-60% put forth effort 85% have health coverage Most know how where to obtain medical care High prevalence of alcohol drug abuse due to a variety of stressors Stigmas of homelessness Vast variety of outdoor recreational activities Cultural Assessment Slightly more females than males Mostly white Christians Subcultures small Mexican Asian Many know how to achieve good health-60% put forth effort 85% have health coverage Most know how where to obtain medical care High prevalence of alcohol drug abuse due to a variety of stressors Stigmas of homelessness Vast variety of outdoor recreational activities Neighborhood/ Community Safety Health dept very involved in providing health services, education information Very good air quality Very good water quality Potential for wildlife disease Vast amounts of rivers lakes potential for drowning Severe weather events potential Potential for fires due to vast forestry Excellent fire police response Domestic violence calls 10.5 per 1000 Neighborhood/ Community Safety Health dept very involved in providing health services, education information Very good air quality Very good water quality Potential for wildlife disease Vast amounts of rivers lakes potential for drowning Severe weather events potential Potential for fires due to vast forestry Excellent fire police response Domestic violence calls 10.5 per 1000 Disaster Assessment/Planning El Dorado County Operational Area Emergency Operations Plan California Emergency Management Agency Federal Emergency Management Agency preparedness plan Following federal guidelines Rescue, medical care, food, shelter, clothing Temporary housing, food stamps, employment Public Health Emergency Response Guide by CDC for emergency preparedness and response Most residents unaware of any plan Disaster plan not readily available or easily found Disaster Assessment/Planning El Dorado County Operational Area Emergency Operations Plan California Emergency Management Agency Federal Emergency Management Agency preparedness plan Following federal guidelines Rescue, medical care, food, shelter, clothing Temporary housing, food stamps, employment Public Health Emergency Response Guide by CDC for emergency preparedness and response Most residents unaware of any plan Disaster plan not readily available or easily found The community genogram shows a relatively healthy mostly white community. As a whole, the people here make a good living, with unemployment below the national average. A small percentage receives food stamps and public cash benefits, also below the national average. Most people have health coverage, and about 60% of the population is proactive with their health. The leading causes of death are cancer and then cardiac disease occurring in the high 80’s of age, due to the large retirement population. The public health department is very involved in providing health services here (CDHP). The air and water quality is good here, with pollution below the national average. There is some potential for bad weather and fires, however, our fire and police response are excellent here. There is a good disaster preparedness plan, however, it is difficult to find, and few know about it. There is a high incidence of alcohol and drug use here, with poor and inadequate coping skills to handle d ifficult life events. The homeless population is really looked down upon here. Within the parameters assessed above, El Dorado County is a healthy community. The areas that need improvement are discovering a way to help people respond in healthy ways to painful life events other than drugs alcohol, to create implement a plan to help the homeless community, to educate the public regarding the causes and preventative measures for Cancer Coronary Artery Disease, and to educate the public regarding emergency disaster preparedness through community outreach programs. Bibliography CDHP. Retrieved from http://www.cdph.ca.gov/programs/Pages/HealthyCommunityIndicators.aspx City of Placerville. Retrieved from http://www.cityofplacerville.org/ El Dorado County Economic and Demographic Profile. Retrieved from http://www.eldoradocounty.org/ Office of Emergency Services (OES). Retrieved from http://www.edcgov.us/Government/Sheriff/Divisions/Support/Office_of_Emergency_Services_

Vesico Vaginal Fistula In Birnin Health And Social Care Essay

Vesico Vaginal Fistula In Birnin Health And Social Care Essay Approximately, about 7 million women were affected from complication of pregnancy and child birth worldwide. Out of the estimates, 6.5million women are from the developing countries. (WHO Global burden of disease 1998). According to the data from West African Journal of Medicine (WAJM 2004; 23 1) the prevalence of obstetric fistula in West Africa is around 1-3 per 1000 deliveries while, in other African region is 5-10 per 1000 deliveries. Report shows that, maternal morbidity and mortality is among the major problem for women in Nigeria. Maternal mortality ratio of 800 deaths per 100,000 live births which is also rated among the highest in the world. The report further stated that for each death that occurred 20 or more women will be affected by childbirth injuries and most of this is obstetric fistula (UNFPA/Nigeria 2005). Obstetric fistula is one of the maternal morbidities and mortality problem in Nigeria which is an issue of concern to Public Health (WAJM 2010; 29 (5); 293-298. The situation is being more evidence in the Northern part of the country, prevalence estimation ranges from as low as 400,000 to as much as 800,000 cases, 5% of these cases are from the Northern region. There could probably be an incidence of 20,000 new cases a year, with approximately 2,000-4,000 fistula repair surgeries being carried out yearly. Also Nigeria count for 40% of the worldwide fistula prevalence (Country assessment UNFPA/Nigeria 2009). Life expectancy of female population at birth is 52 yrs, with a total of 5.5 fertility rate (Unicef 2010). 1 Statistic report from (UNFPA /Nigeria 2005) stated that, majority of fistula patient visited the Health centers are below 20 years. Nigeria is facing a great challenges of Health care providers, with an estimated of 58-39% trained skilled attendance for Ante-Natal and delivery (Midwives) attached to the Health facilities (NDHS 2008). Efforts by the Government to provide them remain unsuccessful. In Nigeria, early marriages contribute 23% of the maternal death that are cause by severe hemorrhage, obstructed and prolong labor which may result to obstetric fistula and often time still birth. 69% of women in the rural areas face difficulties in accessing medical care that made them to have home deliveries by unskilled birth attendant. (Lindros and Lowkkainen 2004). Kebbi State with an estimated population of 3.8million out of it 836,000 are women of child bearing age is located in the North West part of Nigeria. It has a particularly low socio -economic indicators. Maternal mortality rates for the region are estimated at 1,000/100,000 live births (NDHS 2008) Total fertility rate is 8 which are above the national average. According to Leadership News paper 19 April 2012, stated that, kebbi state rank among the highest rate of maternal death in the country. Most of the direct causes of maternal death are hemorrhage, sepsis, eclamsia and anemia. While long and obstructed labor has been responsible for both maternal morbidity and mortality such as vesico-vaginal fistula. According to a survey, the state faces serious maternal challenges. Age at marriage in the state is 12-13 years and most of them became pregnant by 13-14 years. VVF victims can be found in all part of the state with prevalence rate of 5,000-8,000, Birnin Kebbi Local Government has the highest rate of 2,500 cases. (Khalid Zango 1996). Factors accounts for high morbidity in women in the state include social, cultural, economic accessibility and health facility associated problems. 2 Obstetric fistula is can be treated but, poverty, ignorance and lack of information are the most contributing factor for women to seek for medical attention. These high prevalence shows negligence for the government to address the situation. This study actually is going to look in to the Knowledge about the vesico vaginal fistula and the attitude towards it. The study will also be conducted among women with and without vesico vaginal fistula. The result will provide information as to knowledge level regarding vesico vaginal fistula and as to how the women without fistula look at vesico vaginal fistula as a disease and their attitude towards fistula women. 1.2. Research questions study 1.2.1 What is the prevalence of self reported cases of Vesico Vaginal Fistula among married women? 1.2.2. What are the knowledge, attitude and knowledge of preventive measures of women towards vesico vaginal fistula in Birnin -Kebbi LGA of Kebbi- State, Nigeria? 1.3. Research Hypothesis Knowledge, attitude and preventive measures of women towards vesico vaginal fistula living in Birnin Kebbi Local Government of Kebbi State, Nigeria. 3 1.4. Objectives 1.4.1. General Objective To assess the knowledge and attitude towards vesico vaginal fistula in Birnin Kebbi LGA of Kebbi State, Nigeria. 1.4.2. Specific Objectives To study the prevalence of vesico vaginal fistula in Birnin Kebbi LGA. To assess the level of knowledge of married women on the contributing factors of vesico vaginal fistula. To find out if married women knows about preventive measures of vesico vaginal fistula. To determine the attitude towards women with vesico vaginal fistula. To determine the possible risks factors related to status of vesico vaginal fistula. To analyze the association of knowledge and attitude with the status of vesico vaginal fistula. 4 1.5. Conceptual Framework Socio -demographic Age Occupation Education Socio-cultural factors Age of Marriage Patriarchy Gender violence Workload Parity Status of Vesico vaginal fistula Access to health care: Antenatal visit Untrained birth Attendants Post natal Place of delivery Aaaaaa111111 Knowledge about the Risk factors, sign and symptoms and preventive measures of vesico vaginal fistula Attitude of women towards vesico vaginal fistula and women with recto vaginal fistula 1.6. Operational Definitions:- 5 1.6. Operational Definitions:- Age of Marriage: refers to getting marriage below 18 yrs. Poor birth practices: Home delivery by un- skill attendant. Parity: Multiple birth with low spacing. Patriarchy: Head of the house decision is final. Untrained birth attendants: Untrained or self practice in delivery. Knowledge: Knowledge in this study regarding to sign and symptom of VVF. Attitude: In this study refers to the availability of health services and the barriers to seeking. Preventive Measures: Knowledge about steps to tackle the VVF. Status of vesico vaginal fistula:- The status of vesico vaginal fistula in this study is women have obstetric fistula or vesico vaginal fistula 6 CHAPTER 11 LITERATURE REVIEW The chapter 11 deals with the: History Vesico Vaginal Fistula Global situation of vesico vaginal fistula Situation of Fistula in Nigeria Causes of vesico vaginal fistula Social Consequences of vesico vaginal fistula Treatment of vesico vaginal fistul 2.1. History of vesico vaginal fistula Vesico vagianal fistula or obstetric fistula has been identified to be a major issue or women of child bearing age since decades. In 1935 professor Derry from Cairo stated that, the remains of Queen Henhenit (2050 BC) were the oldest to discover fistula. Around 1845 james marion sims was the first surgeon to successfully repair VVF from a 3 female slaves in Montgonery Albana. Later, in 1852 he established a VVF repair centre where many patients from America and Europe came for surgery (Robert F. Zacharin 2008). A discovery during 1550 BC in the ancient Egypt, Aveicenna was a famous Arabian physician to differentiate VVF and obstetric (Derry DE 1935; 42:490). Another innovation came up in 1836 from Peter Mettnauer from Virginia who was identified to be the first surgeon to close fistula in United State (Aust N.Z.J. surg (2000) 70, 851-854.) Study indicates that, during the 19th Century, women with fistula in United State and Europe were caused by dystocia (Russell). In the early 20th century, more experiments and techniques came up to improve the quality of VVF repair. Again, in 1942 Latzko published a new procedure in repairing post -hysterctomy of VVF which recorded 95-100% success (VVF MedScape). Many historical innovations and advanced technique by surgeons has been recorded while, more researches and experiment are still ongoing for the improvement and better solution towards VVF. 7 2.2. Global Situation of Vesico Vaginal Fistula Vesico Vaginal fistula (VVF) which is also called obstetric fistula is an abnormal opening between the urinary bladder and the vagina or between the vagina and the rectum (RVF).This is caused as a result of prolong labor where the child presses against the normal way thereby developing the hole between the vagina and the urinary bladder (WHO def). Globally, 529,000 women were estimated to have died every year due to pregnancy and childbirth related complication. Almost 90 percent of this death is from Africa and Asia. Generally, 5 percent of this death is expected to have experience from obstructed labor (UNFPA/Nigeria 2005). According to M.J Metro report in 2006 indicated as VVF is not new disease it has been in existence for decades. He further highlighted that, in the third world countries mostly in the west 90% of VVF cases are caused by bladder trauma during hysterectomy surgery. Nowadays, advanced technologies from developed countries such as Europe and part of North America have eliminated the disease (VVF) in there region (M.J.Metro 2006). In the same report of metro 2006, he stated that, VVF is an uncomfortable disease the victims should be more serious towards their personal hygiene. In a WHO report of 2006 indicates that, about 2 million women living with untreated VVF, while 50,000 to 100,000 new cases are reported every year (WHO 2006).The increase on figures could be due to stigma that associated with the situation. Also in another report from WHO study on global burden of disease, stated that, if 2% of the obstructed labor are caused by VVF, then 130,000 women are going to be affected with the condition (WHO 1998 243-66). A study report published from UK indicated that, out of 166 cases treated within 18 year, only 21 cases are caused by obstetric complications. Another report from Nigeria stated that, out of 377 cases of VVF 369 cases are caused by childbirth (Lawson J. 1998, 83; 454-456). 8 2.3. Situation of vesico vaginal fistula in Nigeria The millennium Development Goals (MDGs) targeted at reducing the proportion of women dying in childbirth by three quarter by 2015 become unrealistic in Nigeria. (Adeyemi Ezekiel). The reason behind it is that, the country has made less progress in reducing maternal and mortality than any other sub-Saharan African countries. The maternal mortality rate in Nigeria estimated as 800nto 1,500 per 100,000 live birth (WHO 2006). The Northern part of the country has generally worse indicators with an estimated maternal mortality rate of 1,500/100,000 live birth. The high maternal mortality rate affects the basic health services in the country (NDHS 2003). According to UNFPA report, Nigeria approximately to have an estimate of 400,000 and 800,000 women affected with VVF condition while, 20,000 new cases are recorded every year. Most of these patients are from the northern part that lives in the rural areas where they find it difficulties in accessing proper medical care. (UNFPA/Fistula Nigeria 2005). Also statistics shows that, most of the VVF victims are below 20years. The underlying cause of VVF in Nigeria is due to prolong obstructed labor and mostly the young ages are at risk due to early marriage and early childbirth where there body is still in the stage of developing (WHO2006). In 2002, a multi-sectorial committee was setup by the Federal Ministry of Health to find the solution to the problem. At the same time the committee identifies Engender Health along with UNFPA/Nigeria to conduct a nationwide needs assessment in order to develop a framework and action plan for the elimination of fistula in Nigeria. Although Nigeria has been taking measure to address reproductive health and maternal health problems, the implemented interventions have not reach optimum coverage to obtain the desired impact. (NDHS 2008). 9 2.4 TYPES OF FISTULA Many surgeons have described fistula according to their experience during repair. In 1852 Sims also classified fistula by its location in the vagina. According to (Cater, Palumbo et al. 1952) stated that, it is difficult to describe the reported cases of fistula but, the standard method is to identify it during the actual operation and the result. Mayor clinic doctor has briefly classified six types of vaginal fistula Vesico vaginal fistula- is abnormal opening between the vagina and urinary bladder Ureterovaginal fistula- is abnormal opening that connect the vagina and the ducts which carry the urine from the kidney to the bladder. Urethrovaginal fistula- is an opening between the vagina and the tube that carries the urine out. Rectovaginal fistula- an opening between the vagin and the opening anus. Colovaginal fistula- the opening between the vagina and the large intestine. Enterovaginal fistula- an opening between the small intestine and the vagina. 10 2.5. CAUSES OF VVF Many publications and journals have their different versions on the causes of vesico vaginal fistula. According to medicine for African journal classified the factors that contributed to the cause of vesico vaginal fistula as: (MfA- VVF) Primary factor Childbirth: 8% of the VVF cases are prolong and obstructed labor where the deliveries are conducted by untrained skilled birth attendant or as a result of malpresentation of baby in the uterus which cause a lot of damage to the womans urinary tract. Hysterectomy or other gynecological problem:- This can be caused by accidental surgery that occur within the pelvic and may result to VVF. Gishiri cut or Salt cut:- It is a traditional way of treatment by a traditional healers mostly practice in Nigeria and some part of west Africa. When a woman present Gishiri disease symptoms such as vulva itching, absence of menstruation, infertility or obstructed labor. As a result of these symptoms a local surgical cut in the anterior vagina wall of a woman was done for total cure. During removal of clitoris in a process of female Genital mutilation or female circumcision the vaginal tissues and its surrounding will be scrapped thereby causes VVF. Secondary factor Sexual transmission disease or previous pelvic inflammatory disease. Bladder stone or retain foreign body within the vagina Diabetics 2.5.3. Socio-cultural causes The most underlying socio-cultural causes in Nigeria are: Early marriage; harmful traditional birth practices; poverty and illiteracy. 11 2.5.4. Early marriage Early marriage can be define as being marriage at the age of 15-24 years when the reproductive organs are not fully matured for taking responsibility as done by the adult. This will result t damage of the birth canal that will lead to vaginal fistula (John Zang). According to WHO/UNICEF, the recommended age of marriage is 25 to 26 years. In article 16, of the convention on the elimination of all forms of discrimination against women, specified the right to protect child marriage. I n a publication from unicef research centre on early marriage 2001 stated the guidelines on changing attitudes of families and societies towards child marriage. According to global assessment of child marriage it is estimated that, South Asia and Africa has the highest number of young women/young girls who are given out into marriage at the age of 15-24years. These will affect their nutritional status which will lead to so many pregnancy- related complications and most of the time she has no say in making decision for herself. Also in another report from WHO 2006 indicate that: more than 25% of women with fistula from Ethiopia and Nigeria are pregnant before the age of 15years while over 80% of them also become pregnant at 18years of age. 2.6. SOCIAL CONSEQUENCES OF VVF Almost all the report from the medical professional indicates the psychological consequences of women with VVF that bears. This is attributed due to lacj of support from the families and societies as a whole. Majority of these women faces great challenges in the society because of the odour from the incontinence of urine. 12 According to WHO report indicate that, women with VVF are facing difficulties to manage the urinary incontinence that causes odour from urine. The report also highlighted that, due to injury to the vaginal wall many complications may arise even after obstetric repair of the VVF. These complications are narrowing of the vagina, secondary amenorrhea inability to carry the child. However, (Murphy 1981 and Harrison 1983) stated that, the most traumatic aspect of VVF resulting to urinary incontinence and lost of child who sometime may lead to marital separation/divorce and also social excommunication. In another report from (WHO 2006), VVF patients are to be sympathized due to the lower social status of women in Nigeria. The most disheartening is that, they are abandoning by their husband and they have limited role within the family. 2.7. Treatment Women with fistula face a lot of challenges which most of the time find difficult to disclose their situation. The only solution for their survivor is surgery and personal hygiene. A statement from WHO Maternal Health and Safe Motherhood program indicate that, the endemic VVF area should focus prevention aspect through effective social changes that will improve the status of women. 13 CHAPTER 111 RESEARCH METHODOLOGY 3.1. Research Design Cross- sectional survey study among the married women of reproductive age in Birnin Kebbi LGA in Kebbi State, Nigeria. Focus group approach to assess the knowledge and attitude towards vesico vaginal fistula among people who live in Birnin Kebbi LGA, in Kebbi State, Nigeria. 3.2 Study Area Birnin- Kebbi LGA which lies in the centre of Kebbi State of Nigeria. A total of 45 wards :- Nasarawa 1, Nasarawa 11, Dangaldima, Marafa, Gwadangwaji, Zauro, Ambursa, Gulumbe, Ujario, Kardi, Gawasu, ,Makera, Kola, Tarasa, Fadama, 3.3. Study Population The study will be among the married women of reproductive age 15-49yrs of age. 3.4. Sample Technique Selection of Sample sites: Systematic Randomly sampling will be done for the collection of data in 45 settlements from 15 wards 3.4.1 Exclusion criteria are The sample who are not Birnin Kebbi cases The samples have never followed up doctor or refilled medical attention during 3 months prior to study The sample who are unable to communicate verbally and orally to interviewer appropriately 14 3.5. Sample size Yamane sample size Formula n=z2p (1-p) (e) 2 n= (1.96)2 X 0.22 (1-0.22) = 264 (0.05)2 Where , n = sample size p = proportion of women of reproductive age in B/Kebbi LGA that are expected to have knowledge about vesico viginal fistula. e = Marginal error or accepted error z = Standard value of 95% confidence interval of 1.96 Sample size is 264 + 10% to add up in case of any missing value/data, the total sample size will be 264 + 26.4 (10%)= 290 3.6. Measuring Tools Survey questionnaires are to be admitted on knowledge and attitude of married women towards vesico vaginal fistula. Face to Face interview will be carried out during the focus group discussion 3.7. Validity and Reliability test Validity test 3 Expert validity are to be selected from B/K LGA. Questionnaire will be checked and reviewed by these 3 experts. 15 Reliability test Questionnaire will be pr-tested by the respondents who are comparable to the targeted respondents. The reliability of questionnaire will be statistically tested with the Crobachs Alpha, which its acceptable coefficient is more than 0.74 3.8. Data Collection Constructed questionnaires to be used on the followings: Questionnaires General and household information, Knowledge towards the sign and symptom of Vesico Vaginal Fistula. Attitude towards the Preventive Measures on the vesico vaginal fistula Access to the health facility- information and service. Focus group discussion women with and without VVF 3.9. Data Analysis (Statistics) Questionnaire will be coded before entering into the computer. SPSS version 17 will be used Descriptive statistic is to be used to analyze data which will describe the frequency, percentage, mean and standard deviation 3.10. Ethical Consideration Under the guidance of College of Public Health Sciences, and local authorities Interviewees will be informed and explained Informed signed consent 16 Have freedom to withdrawal Confidentiality Convenience Can access to final report or results Not use for other purpose 3.11. Limitation The study will not represent the general population of Birnin Kebbi LGA. Different socio-demographic group may have different practice The study will not represent for other types. 17 REFERENCES LIST Margaret Murphy (1981). Social Consequences of Vesico-Vaginal Fistula in Northern Nigeria. Journal of Biosocial Science, 13 , pp 139-150 doi:10.1017/S0021932000013304 Vesicovaginal fistula. Retrieved from the web 15/08/2006. http://www.emedicine.com/med/topic3321.htm Wall, L. L (1988) Dead Mothers and injured wives: The Social Context of maternal morbidity and mortality among the Hausa of Northern Nigeria. Studies in family planning 29: 341-359 WHO (2006) Obstetric Fistula: Guiding principles for clinical management and programme development. WHP Press: Geneva Zacharin, R F. 1998. Obstetric Fistula. New York: Springer-Verlag Wien. COMPASS 2006 FMOH partnership works to achieve Millennium Development Goal of improving maternal health care Abuja, Nigeria September http://www.compassnigeria.org/site/PageServer?pagename=News_200609_FMoH_Partnership Haddad S, Fourier P: Quality, Cost and Utilization of Health Services in Developing Countries: A Longitudinal Study in Zaire. Soc Science Medicine 1995, 40: 743-753. Metro (2006) Modification of OConnors technique for the treatment of VVF repair described. Abu- Zahr C. Prolonged and obstructed labour, In: Murray C. Lopez A. Ed Health dimensions of sex and reproduction: the global burden of sextually transmitted diseases, HIV, maternal conditions, perinatal disorders and congenital anomalities, Cambridge: Havard University Press for WHO. 1998; 243-66 Ijaiya MA, Aboyeji PA. Obstetric urogenital fistula: the Ilorin experience, Nigeria. West Afr J Med 2004; 23(1):7-9. http://EzineArticles.com/?expert=John_Zhang Article Source: http://EzineArticles.com/1016812 Lawson J. Vesico -Vaginal fistula y a tropical disease. Trans R Soc. Trop. Med Hyg 1998; 83: 454-456 18 11. MfA VVF   Vesicovaginal Fistula www.medicinemd.com/Med/VesicoVaginal_Fistula_en.html 12. About  Vaginal Fistulas   Mayo Clinic www.mayoclinic.org/vaginal-fistulas/about.htm 19 Time Schedule S/N Activities 2012 2013 Jun- Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun July 1 Preparation and paper review x x 2 Detail and tool development x x 3 Ethical consideration x x 4 Research tool try out test validity and reliability x 5 Revise the tool x 6 Recruitment of interviewer team x Field work and data collection x X Data analysis x X Report writing and Presentation x x Budget S/N ITEMS BUDGET Baht 1 Printing questionnaire -Photocopies -Stationery 8,000 Data collection -Photocopies Quest -Souvenir for respondent -Accommodation -Transportation cost -Data processing 21,000 Air fare Miscellaneous 50,000 20,000 Total Thesis document process 99,00

Annotation: Dante?s Inferno, Page 81, L 31 to Page 82, L 63 :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  The encounter between Dante, the main character, and Filippo Argenti, a member of the condemned, deals with Dante’s response to Argenti’s place in hell, his disdain for Argenti, and his symbolic rejection of sin by his actions. Dante has no sympathy towards Argenti even though Argenti is condemned to stay in the slimy River of Styx until the Judgment. Dante holds great animosity towards Argenti carried on from conflicts they have had in life to the putrid circles of hell. The hostility Dante demonstrates marks his progression in his journey of purification. With his unprecedented denouncement of a sinner, Dante has proven his journey through hell has not been traveled in vain, but effectively to cleanse his sins from his soul.   Ã‚  Ã‚  Ã‚  Ã‚  Dante reacts with curses upon hearing the calling of Filippo Argenti. As Dante crosses the River of Styx on a boat with his guide, Virgil, Argenti cries out to Dante from the river for Argenti had recognized a live man on the boat. Upon identifying his partner in conversation, Dante changes his tone and curses Argenti. Dante says, â€Å"May you [Argenti] weep and wail to all eternity, for I know you, hell-dog, filthy as you are.† Dante explicitly curses Argenti, inducing other sinners also condemned to the River of Styx to attack Argenti. As Argenti wails in response to the attack, Dante sails away and thanks God that â€Å"the loathsome spirit† is mangled.   Ã‚  Ã‚  Ã‚  Ã‚  Dante’s actions display a great disdain for Argenti, which had been brought into hell from life on the world above. Dante curses Argenti with rage and strong resentment, obvious evidence that Dante and Argenti do not get along. Dante denounces Argenti and refers to him as a hell-dog. Dante has such immense contempt for Argenti that he refuses to even speak his name. In life, Dante and Argenti had been bitter political enemies, and Dante’s sharp remarks are meant to insult Argenti and his political group. Dante took special measures to make his disdain for Argenti as clear as possible.   Ã‚  Ã‚  Ã‚  Ã‚  By denouncing a sinner, Argenti, for the first time, Dante has shown evidence of purification. Because denouncing a sinner is an acknowledgement of a sin, the sin is expelled. Thus, Dante purifies himself of being wrathful from his own soul by denouncing Argenti. Dante’s journey through the first five circles of hell has hardened Dante’s heart towards sinful men.

The Worldwide Popularity of Latin Music :: Arts

The Worldwide Popularity of Latin Music The most played and listened to music right now almost everywhere in the world is Latin music. It is especially characterized by its rhythm and its exotic instruments. (Revels-Bey) Nowadays, this kind of music is grabbing people’s attention especially in the marketing area because we can see that people are starting to use it in commercials, TV shows, movies, etc. Most people are ignorant of the origins of Latin Music. They just enjoy it but they never wonder how this pleasant music got its mixed sounds and styles together. Latin music has its root in the Moorish culture. This culture emerged when Christopher Columbus came to conquer the new world and he brought with him Moorish slaves into Latin America. The Moorish culture spread its rhythm and sounds among other countries. Its rhythm distinguished its music between other cultures. Moorish descendants used drums and songs in a way to communicate each other. After years, this music spread through all the islands of the Carribean making it their unique musical culture. Each Latin American country adopted some sounds from the Moorish to made their own style. (Revels-Bey) Latin music is a mix of different sounds, beats, and rhythms obtained from Spain and Latin America. The styles of Latin music are: el mambo, la rumba, la zarzuela, flamenco, el tango ,el merengue, la cumbia and salsa El mambo and the rumba are kind of similar in sounds but experts can distinguish them by their beats. They say that the mambo’s musical has unexpected beats and that the rumba starts with a group of improvised verses. La zarzuela and the flamenco are both folkloric music from Spain, but they differ in two points. La zarzuela is from Spanish opera and the flamenco has an influence of arabic and gypsy melodies. El tango is the music from Argentina and it’s characterized by its slow and soft rhythm. El merengue has a fast beat and a tropical rhythm and it started in the Dominican republic. The cumbia has a moderate to rapid melodious verses and choruses. Musicians play it with accordions and drums. Finally, la salsa became popular in Miami and New York and ità ¢â‚¬â„¢s characterized by the use of trumpets and other brass instruments. (Monkeyshines) One of the Latin music styles that most people around the world learn and like to dance to because of its contagious rhythm is Salsa. The Worldwide Popularity of Latin Music :: Arts The Worldwide Popularity of Latin Music The most played and listened to music right now almost everywhere in the world is Latin music. It is especially characterized by its rhythm and its exotic instruments. (Revels-Bey) Nowadays, this kind of music is grabbing people’s attention especially in the marketing area because we can see that people are starting to use it in commercials, TV shows, movies, etc. Most people are ignorant of the origins of Latin Music. They just enjoy it but they never wonder how this pleasant music got its mixed sounds and styles together. Latin music has its root in the Moorish culture. This culture emerged when Christopher Columbus came to conquer the new world and he brought with him Moorish slaves into Latin America. The Moorish culture spread its rhythm and sounds among other countries. Its rhythm distinguished its music between other cultures. Moorish descendants used drums and songs in a way to communicate each other. After years, this music spread through all the islands of the Carribean making it their unique musical culture. Each Latin American country adopted some sounds from the Moorish to made their own style. (Revels-Bey) Latin music is a mix of different sounds, beats, and rhythms obtained from Spain and Latin America. The styles of Latin music are: el mambo, la rumba, la zarzuela, flamenco, el tango ,el merengue, la cumbia and salsa El mambo and the rumba are kind of similar in sounds but experts can distinguish them by their beats. They say that the mambo’s musical has unexpected beats and that the rumba starts with a group of improvised verses. La zarzuela and the flamenco are both folkloric music from Spain, but they differ in two points. La zarzuela is from Spanish opera and the flamenco has an influence of arabic and gypsy melodies. El tango is the music from Argentina and it’s characterized by its slow and soft rhythm. El merengue has a fast beat and a tropical rhythm and it started in the Dominican republic. The cumbia has a moderate to rapid melodious verses and choruses. Musicians play it with accordions and drums. Finally, la salsa became popular in Miami and New York and ità ¢â‚¬â„¢s characterized by the use of trumpets and other brass instruments. (Monkeyshines) One of the Latin music styles that most people around the world learn and like to dance to because of its contagious rhythm is Salsa.

Bone Diseases :: essays research papers fc

Bone diseases most directly influence the ability to walk or to move any part of the body--hands, limbs, neck, and spine. They are related to joint disorders--ARTHRITIS, COLLAGEN DISEASE, DISLOCATION of joints, and RHEUMATISM. The medical specialty pertaining to bone disorders is ORTHOPEDICS. Fractures are the most common bone disorders. They can occur as the result of an accident or be secondary to metabolic diseases. Fractures are life-threatening to aged people having the metabolic bone disease OSTEOPOROSIS, in which bones become porous and brittle. A person, mostly women, having osteoporosis may break a hip during a fall and possibly die from complications. Birth Defects Congenital bone diseases constitute a wide spectrum, ranging from the unimportant--for instance, mild bow legs--to severe lesions, such as spina bifida, in which the lower end of the spine fails to develop properly and the baby is born with paralysis and misshapen vertebrae. Congenital diseases may have hormonal bases: for example, fibrous DYSPLASIA, in which fibrous tissue replaces that of some bones, often results in bone deformity; in addition, some girls with this disease physically mature so early that they are capable of pregnancy and childbirth at the age of seven. Congenital defects also may have genetic bases, as in families who have extra fingers or toes or in the disease osteogenesis imperfecta, in which children have such brittle bones that many are fractured. Disorders of growth and development include several kinds of dwarfism and gigantism. Bones or limbs may develop deformity as the result of known causes, such as the infection poliomyelitis, or unknown or variable causes, such as curvature of the spine (SCOLIOSIS) or CLUBFOOT. Infections Infections of bone, called osteomyelitis, are usually caused by pus-producing bacteria, especially Staphylococcus and Streptococcus. Before the development of antibiotics, children frequently contracted this disease. Today bone infections are introduced primarily through fractures and during surgical operations. People infected with syphilis, tuberculosis, leprosy, or yaws are susceptible to bone damage. Metabolic Disorders Metabolic abnormalities often involve defects in the storage of minerals, particularly calcium and phosphate ions, in the skeleton. Diseases of the kidney can cause a metabolic imbalance of phosphate and calcium so that weakening of the bone occurs. Other metabolic bone diseases are osteoporosis, gout, OSTEOARTHRITIS, and PAGET'S DISEASE. Nutritional Disorders Nutritional deficiencies that result in bone damage include RICKETS in children and osteomalacia in adults, caused by a lack of vitamin D. In children, calcium and phosphate are poorly distributed on bones during development, resulting especially in deformity of the legs and arms. In adults, bones of the spine, pelvis, and legs become demineralized and the bones weaken. SCURVY--caused by a lack of vitamin C--also affects bone tissues. A study in the late 1980s indicated that the mineral boron is nutritionally important, as well. Apparently, it reduces loss of the bone minerals

Analyse the considerations that regulate when an athlete returns to play after an injury Essay

The considerations that regulate when an athlete is able to return to play after an injury includes indicators or readiness to return to play, monitoring progress, psychological readiness, specific warm up procedures, return to play policies and procedures as well as ethical considerations. It is imperative that an athlete’s injury has recovered, their fitness and skills are close to pre-injury levels and also that their confidence in their injury is 100%. Training pain free and having full mobility return to the injured site are clear indicators of readiness for return to play. In order to measure an athlete’s readiness after returning from an injury they must go through various physical tests to test their fitness and basic skills needed to perform in their sport. For example, a netballer returning from an injured ankle would be tested on her agility through drills including side stepping and dogging. Her match fitness could be tested in a practice game situation at training provided she is pain free and has complete mobility. Monitoring progress through both pre-tests and post-tests is essential to an athletes recovery in order to determine if they have or have not gained the necessary fitness and skills after injury. Ongoing tests, discussions between athlete and physio, visual observations of the athlete and video footage are all means which may be used to appropriately measure the athlete’s progress. Thus, appropriate pre and post tests can significantly help trainers to evaluate and develop particular training programs that will help to athlete return to play quicker after an injury. E.g A swimmer could monitor their progress of an injured arm by measuring the range of movement pre and post training. An athlete’s psychological can be effectively measured by discussions between the athlete, coach and sports psychologist, visual observations and anxiety levels. An athlete returning to sport before they’re psychologically ready can lead to fear, anxiety, re-injury, depression and a decrease in performance. For example, a 100m sprinter who tore his hamstring from jumping out of the blocks may find it psychologically tough to reach their maximum force produced pre-injury. An injured athlete may need to go through a more specific warm up and stretching routine in order to achieve maximum recovery and minimise the chance or re-injury. Thus, extra care and time at the injured site is crucial to ensuring that adequate blood flow, increased flexibility and readiness to perform occur. E.g A soccer player may need to do their own specific warm up program set by their physio separate to the team. Return to play policies and procedures vary with sports, as they may be determined by overall governing bodies or by individual sporting clubs. However, coaches, sports administrators and sports medicine practitioners play a vital role in establishing guidelines for when an injured athlete can return or wether they can play with the injury. For example, a water polo player may need to get their pectoral injury cleared by their team physio in order play. Ethical considerations play a vital role in determining when an athlete returns to play. Athletes ask themselves, ‘When is the right time to play?’ Unfortunately, there are internal and external pressures such as temptation, fear of losing their position on the team, pressure from sponsors and media as well as boredom, sometimes luring them into returning to play before they’re ready. Thus, this could easily lead to an athlete using painkillers or similar drugs from rapid advances in drug technology, in order to continue playing.

English as the official language of the U.S. Essay

The English language has already been established as the official language in 28 States; this would beg the question, what made these States pass such an Act, especially since the Courts already designated such a law as being unconstitutional and infringing upon the First Amendment speech rights (Feder, 12). This question will be addressed throughout the paper, which will first consider the legal proceedings that have occurred thus far for this ‘Official English’ movement. The finding of this paper is self-evident in that the objections to this movement have been rendered invalid, largely due to a lack of irrefutable arguments as the paper will demonstrate. The numerous advantages that will be highlighted will argue for, and show, the benefit to the nation – to both the majority as well as the minorities – of making English the official language of the U. S. U. S. Legislature As of the publishing of the CRS Report in 2007, 28 states in the United States have declared English as the official language in their state constitutions. On the flip side, the U. S. Constitution has enacted several laws such as the Voting Rights Act, the Civil Rights Act, and the Equal Educational Opportunities Act in an effort to protect the language rights of the country’s minorities. These Acts authorize, amongst others, the use of voting materials in states and political subdivisions, with instructions in two languages at the same time, as well the use of languages other than English, when deemed essential, to provide effective and efficient public and private services. The U. S. Congress initiated its effort towards the Official English movement in 1984 with ‘The English Language Amendment’ that was proposed for the Constitution, and it culminated when ‘The Language in Government Act’ passed the House in 1996, but failed to do so in the Senate. Amendments to ‘The Language in Government Act’ were later introduced, with the Inhofe Amendment passing in the 109th Congress which affirmed English as the ‘national language’, and later as the unifying language of the U. S. ; at the same time, ensuring the rights of minorities (Feder, 4). Consequent to Amendments that were later introduced, the passage of such Legislature would now largely be a symbolic one with negligible or zero actual effect on the inhabitants of the country, with regards to the legal aspects. This is largely because â€Å"†¦ an affirmation by the Congress of the central place of English in our national life and culture †¦ would not, of its own force, require or prohibit any particular action or policy by the government or private persons. Nor would it, without more, imply the repeal or modification of existing federal or state laws and regulations sanctioning the use of non-English for various purposes,† as stated in Feder, 4-5. Benefits The basic principle upon which the proponents of this movement rest their reason for making English the official language of the United States is that it serves to create a bond of unity. While this bond can be used in order to address any issues through more effective communication between the relevant parties, it also does not rob anyone of their heritage. As stated by Adams, 111, â€Å"All languages and cultures are precious in our history and are to be preserved and maintained. These are not, however, public responsibilities. † Parsimonious equity is another, much touted reason for the movement. Where equity states that all judicial hearings should allow a defendant the right to be heard in the language (s)he is most conversant and comfortable with so as to permit the population to be served by the government. Parsimonious equity, on the other hand, maintains that in order to ensure that the government is not bogged down under administrative costs of ensuring an interpreter for each individual need, an official language must be recognized that will ensure that all legal and government related proceedings be dealt with in English. Such a system remains equitable, as well as, limits the costs associated with such activities (Fishman, 59). With regards to the ‘language-rights’ argument it must be noted that while protecting the rights of minorities in of itself is a sufficiently altruistic and, in the case of the U. S. , required task of the government, it must be ensured that the majority not be discriminated against either. Such a paradox would result in the formation of extreme political parties that would effectively shut out the minorities, due to their large, and united, numbers. In light of this argument, the proponents stress that by officiating the role of the English speaking majority in the United States the government will preclude the establishment of such highly biased and extreme parties, and maintain the unity and equity of the nation. Therefore, while it may be historically justified for minorities to seek redress for past acts of subjugation, as usually happens with minorities, and oppose the majority, it would be more I keeping with the â€Å"interest of [the] linguistic minorities to seek a balance,† as stated by Joseph, 62. To an extent it seems understandable that the minorities might feel as if they are being presented with a raw deal, but when the minorities themselves start supporting the cause for making English the official language this argument against the movement is rendered void, and is in fact turned into another reason for supporting the movement. Such a case was witnessed in Alabama, where the black-majority counties voted for the movement by a significant margin (Tatalovich, 244). Learning from Canada Looking at the northern neighbor of the United States, proponents of the movement have found several examples that corroborate their stand of maintaining a single official language for the country. The numerous political conflicts that Canada has faced over its bilingual official languages status have merely served to show how not to operate in one’s own country, in addition to clearly distinguishing the effect of considering the language issue as irrelevant and trivial. As stated by Ricento, 37, â€Å"the disconcerting strength gathered by separatism in Canada contains a lesson for the United States and its approach to bilingual education. † In trying to placate a larger amount of people by using its dual official language system, Canada has only shown to its more powerful neighbor how it is sometimes in the interest of the minorities to ignore their protests and support the decision of the majority. By catering to the Quebec speaking individuals in their country Canada has given them the right to lose out on greater economic benefits as shown by the research conducted by Li, 135-136: the effect of the use of an official language is signified by the â€Å"†¦$911 [male earnings] above the mean even after controlling for other variables,† and similarly, in the U. S. (Zavodny, 449). Conclusion The English language is the language of the majority as far as the U. S is concerned. There has been a movement towards making it the official language of the country in addition to it being so in over half the States already. However, this movement has subsequently led to the minorities crying foul over the perceived loss of their rights and the perceived inequitable behavior that they expect. The proponents of this movement, on the other hand, cite the greater cause of national unity, as well as that of parsimonious equity to vie with the concern of future lost income of minorities. It is the duty of the Government to now realize the potential benefits that will result in letting Acts based on making English the official Language through Congress. Especially since the greatest objection of minority language rights and perceived subjugation by the majority has been proven to be baseless in light of the Alabama vote. The remaining minorities should seek to overcome their emotional attachment to their original heritage, and understand that this movement will not necessarily threaten their roots; instead, it will result in greater opportunities for them through a more equitable treatment at court and business. Beyond these realizations, the government should initiate a budget towards facilitating the teaching of English to immigrants who cannot afford to learn it through their own devices. This is in light of the view that current instructions for the English language, in the United States, are inadequate to prepare them for their future life in the country (Citrin, 108). With Canada serving as an example of the effects of having more than one official language, the United States can ensure that it does not fall into the same trap by creating the equivalent Spanish-speaking enclaves in their country. Economically, politically, and culturally, having only English as the official language will help deal with a lot of problems along these facets of life that will prove to, over time, strengthen the role of equality in the society – a value that is immensely appreciated in the current era, especially in these neck of the woods. Eventually this movement will succeed, because it not only enjoys widespread support from the majority and a few minorities of the U. S. , but it has also managed to secure enough political support behind it to make it a key bill: one that is presented to the Congress in almost every sitting since the mid-1890’s. Works Cited Adams, K. L. & Brink, D. T. Perspectives on Official English: The Campaign for English as the Official Language of the USA. Walter de Gruyter. Fishman, J. A. The Rise and Fall of the Ethnic Revival: Perspectives on Language and Ethnicity. Walter de Gruyter. (1985). Joseph, J. E. Language and Politics. Edinburgh University Press. (2006). Ricento, T. & Burnaby, B. Language and Politics in the United States and Canada. Lawrence Erlbaum Associates. (1998). Tatalovich, R. Nativism Reborn? : The Official English Language Movement and the American States. University Press of Kentucky. (1995). Citrin, J. â€Å"Language politics and American identity. † Public Interest. (1990): p96-109. Feder, J. â€Å"English as the Official Language of the United States: Legal Background and Analysis of Legislation in the 110th Congress. † CRS Report for Congress. (January 25, 2007): pp18. Li, P. S. â€Å"The Economics of Minority Language Identity. † Canadian Ethnic Studies. (2001):