In this presentation we consider some of the factors that influence whether women in Zambia go straight to hospital for a legal, safe abortion, or whether they take alternative complex routes, risking their health for an unsafe abortion.
Risk and stigma in seeking care and policy implicationsIrma Kirtadze M.D.
The study is assessing the development of an efficacious comprehensive women-centered drug treatment model. This presentation demonstrates results from qualitative research.
privacy and dignity violation has become a common practice for health care providers which is hampering the mental health of patients. we discuss measures to stop this malpractice
Risk and stigma in seeking care and policy implicationsIrma Kirtadze M.D.
The study is assessing the development of an efficacious comprehensive women-centered drug treatment model. This presentation demonstrates results from qualitative research.
privacy and dignity violation has become a common practice for health care providers which is hampering the mental health of patients. we discuss measures to stop this malpractice
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Disease screening and screening test validityTampiwaChebani
Full lecture covering screening tests and validity testing. Covers topics such as calculation and interpretation of sensitivity, specificity, positive predictive value and negative predictive value of a screening test.
Patients' satisfaction towards doctors treatmentmustafa farooqi
The mood of the care recipient to see if the impression (expectations) of service are met by the patient may be defined as patient satisfaction. The current perspective on service efficiency tends to be that patient treatment meets public standards and requirements in terms of interpersonal support as well as professional assistance. (Hardy et al. 1996).
For various reasons, customer satisfactions in the healthcare industry have been investigated. First it was important to decide on the extent and the degree to which patient care seekers, the meeting of drugs criteria and the continuous use of these services have effect, satisfaction as a quality of service metric, as well as allowing doctors and health services to better appreciate and use the input of the patient. (Ong et al. 2000).
Consumer satisfaction with healthcare services is a multi-panel term that refers to the core facets of treatment and suppliers, while PS medical services with the quality enhancement systems from the patient context, full control of quality and the intended outcomes of services are considered to be of primary importance (Janicijevic et al. 2013).
The Pakistani health system is being changed somewhat and there are wonderful scope for applying standard of services to health care. Patients in Pakistan now have access to increased quality health care. Obviously, the staff and staff are the most important winners of a successful health care environment of every community sector framework (Bakari et al. 2019).
The medical clinic of today's study is the product of a long and complicated war of civilization to quantify produce and study and to give thought to the thoughtful (Fullman et al. 2017).
A presentation given at a small, closed, high-level discussion workshop on unsafe abortion in Zambia organised by Marie Stopes Zambia and Ipas with support from the ESRC-DFID funded Pregnancy termination trajectories in Zambia: the socio-economic costs study. The presentation discusses four themes in determining whether participants in our study had gone to hospital for a safe, legal abortion or had been taken to hospital for care following an unsafe abortion carried out elsewhere: the influence of advice, perceptions of risk, delays in care seeking and receipt and the economic costs.
How, and in what ways, are rates of contraceptive use and induced abortion linked? What reasons do women give for contraceptive (non-)use for a terminated pregnancy?
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Disease screening and screening test validityTampiwaChebani
Full lecture covering screening tests and validity testing. Covers topics such as calculation and interpretation of sensitivity, specificity, positive predictive value and negative predictive value of a screening test.
Patients' satisfaction towards doctors treatmentmustafa farooqi
The mood of the care recipient to see if the impression (expectations) of service are met by the patient may be defined as patient satisfaction. The current perspective on service efficiency tends to be that patient treatment meets public standards and requirements in terms of interpersonal support as well as professional assistance. (Hardy et al. 1996).
For various reasons, customer satisfactions in the healthcare industry have been investigated. First it was important to decide on the extent and the degree to which patient care seekers, the meeting of drugs criteria and the continuous use of these services have effect, satisfaction as a quality of service metric, as well as allowing doctors and health services to better appreciate and use the input of the patient. (Ong et al. 2000).
Consumer satisfaction with healthcare services is a multi-panel term that refers to the core facets of treatment and suppliers, while PS medical services with the quality enhancement systems from the patient context, full control of quality and the intended outcomes of services are considered to be of primary importance (Janicijevic et al. 2013).
The Pakistani health system is being changed somewhat and there are wonderful scope for applying standard of services to health care. Patients in Pakistan now have access to increased quality health care. Obviously, the staff and staff are the most important winners of a successful health care environment of every community sector framework (Bakari et al. 2019).
The medical clinic of today's study is the product of a long and complicated war of civilization to quantify produce and study and to give thought to the thoughtful (Fullman et al. 2017).
A presentation given at a small, closed, high-level discussion workshop on unsafe abortion in Zambia organised by Marie Stopes Zambia and Ipas with support from the ESRC-DFID funded Pregnancy termination trajectories in Zambia: the socio-economic costs study. The presentation discusses four themes in determining whether participants in our study had gone to hospital for a safe, legal abortion or had been taken to hospital for care following an unsafe abortion carried out elsewhere: the influence of advice, perceptions of risk, delays in care seeking and receipt and the economic costs.
How, and in what ways, are rates of contraceptive use and induced abortion linked? What reasons do women give for contraceptive (non-)use for a terminated pregnancy?
This presentation outlines three commonly encountered scenarios and the ethical and legal issues that may affect the choice of contraceptive. Obstetricians and gynaecologists play a key role in counselling women. Decisions regarding contraceptive choices must take into account women’s preferences, cultural and religious beliefs as well as any co-existing medical issues.
In this presentation we look at the role of induced abortion in country's transitions from having high rates of fertility to low rates of fertility. It draws on micro-level data from Zambia to explore macro-level trends.
Poster for the 2018 Society for Teachers of Family Medicine Annual Meeting: A...Christina Czuhajewski
Presented at the 2018 STFM Annual Meeting, entiteld: Adolescent Views on Prescription and Nonprescription Opioid Use: Findings from the MyVoice Longitudinal Mixed Methods Study
Summary of findings from qualitative study that examined circumstances prompting HIV testing among trans women in Indiana. This presentation was delivered at the Association of Nurses in AIDS Care Conference in Atlanta, GA in November 2016. The paper, HIV testing and entry to care among trans women in Indiana was published in the Journal of the Association of Nurses in AIDS Care: http://dx.doi.org/10.1016/j.jana.2017.05.003
This presentation answers the question 'Why do sexual and reproductive health and rights (SRHR) matter?', drawing on data generated on the social and economic costs of unsafe abortion in Zambia.
The presentation was made to members of the Present Purpose Network (PNN), an organisation of female practitioners and policy makers working to find solutions to problems that impact young women and their local and international communities. The meeting brought together about 20 women from Asia, Europe and N America online for an audio and visual e-conference.
A presentation given at a small, closed, high-level discussion workshop on unsafe abortion in Zambia organised by Marie Stopes Zambia and Ipas with support from the ESRC-DFID funded Pregnancy termination trajectories in Zambia: the socio-economic costs study. The presentation estimates and compares the costs to the Zambian health system of providing post abortion care following an unsafe abortion rather than safe abortion services. It finds that the Zambian healthcare system spends 2.5 times more treating complications arising from unsafe abortion than would be spent on providing safe abortion for these cases.
Discussion of research uptake and impact activities and reflections from our work on unsafe abortions in Zambia: ESRC DFID Poverty Alleviation ConferenceTuesday 9 September 2014
Leone, T., E. Coast, D. Parmar & B. Vwalika "The socio-economic burden of unsafe abortion for women and households in Zambia" Paper presentation at BSPS Annual Conference, University of Winchester, 8-10 September, 2014
Zambia has permitted terminations of pregnancy, under a range of conditions, since 1972. Despite this, levels of unsafe abortion are alarmingly high. Although it’s widely understood that unsafe abortion is both a cause and a consequence of poverty, there is a lack of economic evidence around the experiences of women and their households.
The aim of the study is to compare the socio-economic burden of those who seek safe abortion (SA) with those who seek post-abortion care (PAC) after an unsafe procedure. We use hospital based data collected in the University Teaching Hospital in Lusaka over a period of 12 months in 2013. Information on women’s demographic and socio-economic characteristics, and direct and indirect costs incurred have been collected and triangulated using medical notes and qualitative information. To the best of our knowledge this is the first study to look at the economic burden of abortion on women in Zambia.
Results show that a quarter of the women interviewed (n=114) had attempted to terminate the pregnancy unsafely, and were more likely to have a poorer socio-economic background. The burden is considerably higher for PAC than SA: the equivalent of 2 day’s wages. The policy implications of this study are relevant for the implementation and scaling up of safe abortion services in Zambia.
This presentation was part of a group discussion based workshop we will hosted at the ESRC DFID Poverty Alleviation Conference in London on 9 September 2014
Zambia has permitted terminations of pregnancy, under a range of conditions, since 1972. Despite this, levels of unsafe abortion are alarmingly high. Although it’s widely understood that unsafe abortion is both a cause and a consequence of poverty, there is a lack of economic evidence around the experiences of women and their households.
This presentation compares the socio-economic burden of those who seek safe abortion (SA) with those who seek post-abortion care (PAC) after an unsafe procedure. We use hospital based data collected in the University Teaching Hospital in Lusaka over a period of 12 months in 2013. Information on women’s demographic and socio-economic characteristics, and direct and indirect costs incurred have been collected and triangulated using medical notes and qualitative information.
This short presentation was made at the Zambia Medical Association 2014 Annual General Meeting. It was given by one of the members of the project team, Dr Bellington Vwalika who is Head of the Obstetrics & Gynaecology Department at the University Teaching Hospital, Lusaka. It's a short (10 minute) summary of the pregnancy termination law in Zambia and the headline findings from our study of the costs and consequences of unsafe abortion for women, their households and others and for the Zambian health system.
More from Pregnancy termination trajectories in Zambia: the socio-economic costs (8)
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
Factors affecting pregnancy termination trajectories in Zambia
1. Pregnancy termination
trajectories in Zambia
Dr Ernestina Coast (London School of Economics)
Dr Susan F Murray (King’s College London)
Presentation to the Maternal and Neonatal
health Group , LSHTM, 3rd July 2014
2. Background
• The Termination of Pregnancy Act, enacted in
1972 and amended in 1994 legalises induced
abortion in wide range of circumstances in which
“account may be taken of the pregnant woman’s
actual or reasonably foreseeable environment or
of her age”
• The Penal Code criminalises unsafe and illegal
terminations
• Unsafe abortion continues to be a leading cause
of maternal death in Zambia
3. Aim: broader study
• Contribute to understanding why the public
sector investment in safe abortion services in
Zambia is not fully used by women seeking to
terminate a pregnancy
• Compare trajectories of individuals seeking
induced abortion within a hospital
environment with the trajectories of those
receiving abortion-related care there following
a termination initiated elsewhere
4. Aim: this presentation
• Describe and compare trajectories of
individuals seeking induced abortion within a
hospital environment with the trajectories of
those receiving abortion-related care there
following a termination initiated elsewhere
5. Methodology
• Hospital-based approach
• Qualitative interviews with women
immediately following discharge after TOP or
PAC (n=112, refusal rate=13%)
• Collation and analysis of accompanying
medical notes
• Framework analysis used to facilitate within
and across case descriptive and explanatory
analysis
8. Hospital-based design doesn’t capture
safe/unsafe dichotomy
• Some women presenting for PAC had initiated TOP using clinical
methods elsewhere – some legally (TOP in Zambia must be
carried out “in hospital”), some illegally; some safely, some less
safely
Not all TOP initiated outside study hospital is
unsafe
Hospital TOP
Safe Unsafe
Hospital PAC Hospital PAC
Safe(r)
9. • Developed 3 typologies of the trajectories for women
receiving care in public sector hospital
• Typologies:
– Give better purchase on the data and help
explain difference (Ritchie and Lewis 2003)
– Help identify points of intervention
3 typologies identified
10. MA MA & MVA MVA
Hospital TOP sought
Arrives at hospital for TOP
Referral clinic
× Barriers at or before hospital not
overcome
Presence or absence of complications
Typology 1
11. MVA performed in non-hospital setting or MA commenced
with non-hospital clinical input (e.g. pharmacist)
Review, antibiotics 2nd dose MA MVA
‘Clinical’ TOP sought
from non-hospital
× TOP completed without
complications
× Complications from successful
or unsuccessful TOP treated
outside hospital
× Death
Arrives at hospital for abortion-related care
TOP unsuccessful
without complications
Presence or absence of complications
Referral clinic
Typology 3
Typology 2
12. Non-clinical TOP performed
Review, antibiotics,
other treatment (e.g.
blood transfusion) MA MVA
Non-clinical TOP sought
Typology 3
× TOP completed without
complications
× Complications from successful or
unsuccessful TOP treated outside
hospital
× Death
Arrives at hospital for abortion-related care
TOP unsuccessful
without complications
Referral clinic
Typology 2
Presence or absence of complications
13. First attempt
Includes 2 ambiguous
cases
No information
about 3 (7%)
1 attempts third non-
clinical TOP
112
women
34 (89%) go to
hospital
Second attempt
Government hospital
2 (50%) attempt
TOP with non-
hospital clinical
methods
2 (50%) attempt
TOP with non-
clinical methods
71 (63%) report going
straight to hospital
11 (15%)
receive referral
2 (50%)
receive referral
14 (34%) attempt
TOP with non-
hospital clinical
methods
24 (59%) attempt
TOP with non-
clinical methods
4 (11%) seek an
alternative
method
22 (65%)
receive referral
41(37%) visit
different providers
Study participants’ complex trajectories
14. First attempt
Includes 2 ambiguous
cases
No information
about 3 (7%)
1 attempts third non-
clinical TOP
112
women
34 (89%) go to
hospital
Second attempt
Government hospital
2 (50%) attempt
TOP with non-
hospital clinical
methods
2 (50%) attempt
TOP with non-
clinical methods
71 (63%) report going
straight to hospital
11 (15%)
receive referral
2 (50%)
receive referral
14 (34%) attempt
TOP with non-
hospital clinical
methods
24 (59%) attempt
TOP with non-
clinical methods
4 (11%) seek an
alternative
method
22 (65%)
receive referral
41(37%) visit
different providers
Study participants’ complex trajectories
• Visit to the doctor’s home for
TOP
• MA pills from a pharmacist
• MA pills from a friend
15. First attempt
Includes 2 ambiguous
cases
No information
about 3 (7%)
1 attempts third non-
clinical TOP
112
women
34 (89%) go to
hospital
Second attempt
Government hospital
2 (50%) attempt
TOP with non-
hospital clinical
methods
2 (50%) attempt
TOP with non-
clinical methods
71 (63%) report going
straight to hospital
11 (15%)
receive referral
2 (50%)
receive referral
14 (34%) attempt
TOP with non-
hospital clinical
methods
24 (59%) attempt
TOP with non-
clinical methods
4 (11%) seek an
alternative
method
22 (65%)
receive referral
41(37%) visit
different providers
Study participants’ complex trajectories
• Overdose of combined oral
contraceptive pill Microgynon
• Overdose of paracetamol
• Unknown pills from a partner
• Insertion of small pipe
• A stick from a herbalist
16. First attempt
Includes 2 ambiguous
cases
No information
about 3 (7%)
1 attempts third non-
clinical TOP
112
women
34 (89%) go to
hospital
Second attempt
Government hospital
2 (50%) attempt
TOP with non-
hospital clinical
methods
2 (50%) attempt
TOP with non-
clinical methods
71 (63%) report going
straight to hospital
11 (15%)
receive referral
2 (50%)
receive referral
14 (34%) attempt
TOP with non-
hospital clinical
methods
24 (59%) attempt
TOP with non-
clinical methods
4 (11%) seek an
alternative
method
22 (65%)
receive referral
41(37%) visit
different providers
Study participants’ complex trajectories
T1
17. First attempt
Includes 2 ambiguous
cases
No information
about 3 (7%)
1 attempts third non-
clinical TOP
112
women
34 (89%) go to
hospital
Second attempt
Government hospital
2 (50%) attempt
TOP with non-
hospital clinical
methods
2 (50%) attempt
TOP with non-
clinical methods
71 (63%) report going
straight to hospital
11 (15%)
receive referral
2 (50%)
receive referral
14 (34%) attempt
TOP with non-
hospital clinical
methods
24 (59%) attempt
TOP with non-
clinical methods
4 (11%) seek an
alternative
method
22 (65%)
receive referral
41(37%) visit
different providers
Study participants’ complex trajectories
T2
18. First attempt
Includes 2 ambiguous
cases
No information
about 3 (7%)
1 attempts third non-
clinical TOP
112
women
34 (89%) go to
hospital
Second attempt
Government hospital
2 (50%) attempt
TOP with non-
hospital clinical
methods
2 (50%) attempt
TOP with non-
clinical methods
71 (63%) report going
straight to hospital
11 (15%)
receive referral
2 (50%)
receive referral
14 (34%) attempt
TOP with non-
hospital clinical
methods
24 (59%) attempt
TOP with non-
clinical methods
4 (11%) seek an
alternative
method
22 (65%)
receive referral
41(37%) visit
different providers
Study participants’ complex trajectories
T3
19. Four themes
1. The influence of
advice
2. Perceptions of risk
3. Delays in care
seeking and receipt
4. The economic costs
All influence
either the
direction of
trajectory (the
typology), its
complexity or the
timing of the
trajectory
20. • The advice respondents sought and received, or did
not seek, played significant role in shaping their
trajectories
• Respondents’ relationships with significant others
influenced who was told about their pregnancy, the
decision to terminate it, how and where it was
terminated and whether PAC at hospital was sought
and when
• It was typically others’ knowledge of different service
providers that shaped how women of typologies 1 &
2 navigated care seeking
The influence of advice
21. The influence of advice: typology 1
04023 is 33 years old and married. She has two children aged under 3 and lives in
a township with her husband. They both run small businesses and just get by. Her
pregnancy was unplanned and unexpected – they had been using condoms.
“I called a friend, I explained my situation. // And she gave me a [study hospital]
doctor’s number and who I called.”
22. The influence of advice: typology 2
04009 is 17 years and works as a housemaid. She went for a pregnancy
test at the local clinic with her sister. The pregnancy was unplanned but
not unwanted by all. Her partner wanted to continue with the pregnancy
while she reports getting mixed messages from “other people”. Ultimately
she didn’t feel ready for a child. She attempts to terminate her pregnancy
with tablets from a friend before attending a local clinic and then on her
mother’s advice, the study hospital for PAC.
“It was my friend, I had told her… She is my friend and I have known her
for a long time now. I told her and I asked her if she knows medicine for
aborting… She said there is someone I know but these things are
dangerous you may die together with the child and I told her to just get
for me…One was for drinking and the others 4 for inserting… [I] started
paining around 23 hours… [I] went to [local] clinic. They referred me
here. // I told mum at home [that I had taken the medicine], yes that’s
when she told me that we go to the clinic and she told me that I should
have told her.”
23. The influence of advice: typology 3
03010 is 28 years old, married and daughter who is still very young. She
kept both her pregnancy and subsequent actions secret from her husband
I: So when you knew that you were pregnant did you do anything to try
and terminate it?
R: I only had some Panadol… I only took two
She reports continuing to take her contraceptive pills, possibly hoping to
precipitate a miscarriage. When the pregnancy continued, she escalated
her attempts and went to a herbalist
“I was given something to insert… I was given medicine, a stick… They
inserted it themselves”
Subsequently, her husband brought her to the hospital at night, as an
emergency admission, after telling her husband that she had high blood
pressure. She seems to have had no knowledge of the possibility of a
safe(r) TOP.
24. Perceptions of risk
• Respondents reported that they and those they
confided in considered risks of various TOP methods
• Government providers (clinics and hospitals) were
widely trusted and considered safe
• Avoidance or reduction of risk influenced women’s
selection of non-hospital MA versus non-clinical
methods (Typology 2), and the selection of non-
clinical method (Typology 3)
• However for some respondents the risks of harm
were outweighed by the desire for a TOP
25. 04011 is young and lives with her parents and brothers. She did not tell
her family, but asked her friends for advice on how to terminate her
pregnancy.
“They told me to try herbs from people. I told them I can’t because I
don’t trust them, you can die”.
On the advice of a different friend she looks for MA drugs, at first in her
local drug store and then in the town.
“So I had gone to a drug store near where I stay but they said that they
don’t do that. So my friend told me a friend of hers had done it with a
certain medicine in a white box they are 5 in it, that’s how she wrote for
me on a paper and I went to buy in town.”
When the MA causes her pain she tells her mother who took her to the
local government clinic.
Importance of risk: typology 2
26. 03006 is young, at school and lives with her mother. Having decided to
terminate her pregnancy, she found her friends discussing various non-
clinical methods and selected the one she thought was safest.
“I found that there about of six of them there and they were busy
chatting about methods that should be used for aborting the
pregnancy… then I went home and decided to try whatever they were
saying. That Cafemol really drugged me, felt like I was dying… I took
twenty Cafemol tablets.//
They said a lot of things that people take to terminate the pregnancy… I
heard that you can drink Coca-Cola with some tablets, some were saying
you drink Jerico [hair gel], some said you should drink Cafemol. A lot was
said even for using sticks.
I: So of all the stuff said, you chose to use Cafemol?
R: Yes, felt that it safer.”
Importance of risk: typology 3
27. Delays in care seeking and receipt
• Delays in care seeking common, particularly
among women of typologies 2 and 3. Health
implications of delays are considerable
• Some delays were connected to the healthcare
system – long queues, forgotten appointments
and economic costs
• Lengthier delays appear to be linked to denial of
pregnancy or non-disclosure of previous TOP
attempts to clinicians associated with stigma of
unplanned pregnancy and induced abortion ,
especially among younger women of typology 3
28. When the Cafemol taken by 03006 begins to cause her heavy bleeding, discharge
and pain, she starts a lengthy process of care seeking:
“I was just feeling okay until after two weeks when I started wondering if I was
rotting... That started worrying me a lot //
[I] went to [local clinic]. I explained to them something else because I was
scared to tell them that I did something. They gave me prescriptions there but I
did not buy the medicine because I knew that it was the wrong medicine. I went
home and my mother asked me if I was given any medicine and I said yes. I
tried to hide from my mother for few days but I [then] decided to tell her what
was happening //
I: So from the clinic, you went home and what happened next?
R: I got sick that I could not move out of bed because of the pains... I then
decided to tell my mother about what happened… She was very annoyed with
me... I stayed for three days, very sick... On the third day, she called me from
work and told me to meet her at some station so that she can take me to [a
local clinic]
She was referred to the study hospital for sepsis.
Delays associated with non-disclosure: typology 3
29. The economic costs
• In this sample of women who accessed hospital-based care,
financial costs of seeking a TOP appear to influence the timing
and complexity of trajectories, rather than the choice of TOP
method and provider
• The hospital served a large area and finding money for
transport was a first hurdle. Study not able to capture women
who could not overcome it
• In order to increase efficiency in tertiary care, people are
given economic incentives to access district clinics first: a
referral from a satellite health centre reduces registration fee
at a hospital from K80 to K10. For poorer women, knowledge
of how to navigate the public sector health system made care
affordable but also added an additional step in their trajectory
to the hospital
30. • For other women, the clandestine cost of a TOP within the
hospital could be significant, and introduce further delays
02002 is 20 years old, from a poor family and stays with her mother’s friend
(‘aunty’) as a maid. She wanted a TOP because her widowed mother and her
would not be able to care for a child. She told her aunty who called a hospital
doctor for a TOP and they came to the hospital. However they were charged
more than they expected and had to leave to find the outstanding balance.
Only when returning a several weeks later was she given a medical abortion.
I thought that… when we got here, everything would happen. That I would
be admitted and given some medicine, but than that did not happen there
and then, two weeks passed and I was told to comeback… Yes, I had come
before, almost a month ago… About the money. We did not manage the
money that we were told was not enough… We thought that maybe we
would be charged 100, so that is the money we come with. So we gave him a
100 and had a balance of 200 [still to pay]. So that is how we went
back….We paid 200 [today], but it is not enough yet, we still have a balance.
Clandestine payment to doctors: typology 1
31. 02008 is married with three children, the youngest of which she was still
breastfeeding. When she found out she was pregnant, she continued to take
her family planning pills, including taking all of the “red pills in the
Microgynon packet”, hoping that it would help her miscarry. When this did
not work she took some other (unspecified) tablets. When she started
bleeding heavily, however, she did not feel that she could afford not to open
her market stall, so she delayed seeking care. When she eventually went to
the study hospital, she is at first sent away and told to return the following
day when a clandestine fee was charged.
I: OK so what happened with the doctor [when you came yesterday]?
R: Well, he was difficult, he told me that it’s not allowed by the Government
I: OK, what else did the doctor say to you?
R: He told me that he would help me, and that this should not happen again
The respondent subsequently revealed, after extensive probing, that the
doctor had charged her K200 for treatment. She was very reluctant to reveal
what she had paid: “Won’t I be taken to the police?”
Clandestine payment to doctors: typology 3
33. Knowledge of safe hospital-based TOP
• Care-seeking trajectories of women who knew that safe TOP
services were available from government hospitals was relatively
straightforward
• However for those unaware of these services, the process to
achieving a TOP is more complex: the nature of their trajectory
influenced by advice from others and evaluation of risks; the
pace of their trajectory influenced by the costs of services and
the process of disclosure
• Process of attaining TOP often began within their immediate
social networks. The false perception that abortion is prohibited
contributed to steering women towards clandestine methods or
clandestine payments for safe and legal treatment
34. Implications of typology 2
• Research identified a second typology of women who had
received medical abortion (MA) outside of the study hospital
setting
• Widespread availability of medical abortion in pharmacies and
clinics means that there is likely to be a reduction over time in
the number of women seeking either TOP in hospital or PAC
following induced abortion
• Although the Zambia TOP Act does not permit administration of
TOP outside of hospitals, MA bought from a pharmacist and not
administered by a health-care provider may be safer and more
effective than other methods, such as inserting objects into the
cervix or herbal remedies
35. And finally….
• http://personal.lse.ac.uk/coast/ZambiaTOP.htm
• Additional components (writing)
– Health system costing
– Individual and household costs and consequences
– Contraception and (un)intended/(un)wanted pregnancy
– Male involvement
– Ethics
• Impact Maximisation Grant (2014-15)
THANK YOU