Introduction The aim of this study was to determine how recommendations of gynaecologists on surgical treatment for stress urinary incontinence (SUI) were influenced by patient characteristics. Methods Two hundred forty-five gynaecologists in the UK fully responded to an online questionnaire including 18 vignettes describing 7 clinical characteristics of women with SUI (age, body mass index, SUI type, previous SUI surgery, frequency of leakage, bother, physical status). The gynaecologists scored recommendations for surgery ranging from 1 'certainly not' to 5 'certainly yes'. Mean scores were used to calculate the relative impact ('weight') of each clinical characteristic. Latent class analysis was used to distinguish groups of gynaecologists with a particular practice style because they responded to the patient characteristics captured in the case vignettes in a similar way. Results The gynaecologists' overall average recommendation score was 2.9 (interquartile range 2 to 4). All patient characteristics significantly influenced the recommendation scores (p always < 0.001) but their impact was relatively small. SUI type was most important (weight 23%), followed by previous SUI surgery (weight 21%). Latent class analysis identified five groups of gynaecologists with practice styles that differed mainly with respect to their mean recommendation score, ranging from 1.3 to 4.0. Conclusions Surgical treatment advice in response to case vignettes was only minimally influenced by patient characteristics. There were five groups of gynaecologists whose inclination to recommend surgical treatment varied. This suggests that there is lack of consensus on the role of surgery as a treatment for SUI. A considerable number of gynaecologists were reluctant to recommend surgery.
Background: Maternal and child mortality remain major global public health challenges. Majority of the world’s maternal mortality occur in low–income countries including Ghana, where financial barriers make maternal healthcare inaccessible to many womenduring obstetric emergencies, resulting in avoidable maternal deaths. Ghana implemented a free maternal care policy nation-wide in 2008 .to provide pregnant women antenatal, delivery and postnatal care in public, and accredited private healthcare facilities. This work assesses the impact of the policy on selected Maternal and Child Health (MCH) indicators in Ghana.Methods: Literature on financial barriers to maternal healthcare in Low Income Countries (LICs) was reviewed. WHO databases were searched for MCH indicators for Ghana from 2000-2011, aggregated and trends analysed. Additional data was obtained from Maamobi Polyclinic, Koforidua Regional Hospital (KRH), and the Korle Bu Teaching Hospitals (KBTH). These were statistically analysed for trends to assess the policy’s impact on these indicators.Results: Over four years of implementation, average antenatal coverage increased by 2%, skilled birth attendance 11%; contraceptive prevalence unchanged and unmet need for contraception rose marginally. Under-5 mortality declined by 22%. KBTH recorded increased antenatal (ANC) attendance and decreased annual deliveries that were non-significant. Maternal Mortality Rate (MMR) increased by 89/100,000LB; Caesarean section (C/S) rate rose by 5.5%, fresh still birth (FSB) rate increased and Neonatal intensive careunit (NICU) admissions surged 21%. KRH recorded significant increases in deliveries by 2114; C/S rate by 3% while MMR reduced by 0.56% (562/100,000LB). However, the FSB proportion increased by 13%, ANC attendance reduced by 567, annual deliveries rose by300, C/S rate and FSB increased by 3% and 11% respectively per year at the Maamobi Polyclinic.Conclusion: Encouraging trends were observed in the MCH indicators attributable to the policy. Increasing FSB rates indicate inadequate care quality especially intra-partum monitoring possibly due to over-stretched staff and facilities from rising patient loads.
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