BackgroundAn institutional delivery is a childbirth that takes place at a health facility in which the birth is assisted by a skilled healthcare provider. Institutional delivery could reduce approximately 33% of maternal deaths. However, the use of institutional healthcare is failing in many Sub-Saharan African countries because of many factors, including poverty, a lack of access, distance, a lack of transport and other socio-cultural factors. In Somalia, only 32% of births are delivered in a health facility with the assistance of a skilled healthcare provider. We aim to investigate the factors hindering women from giving birth at health facilities in major towns in Somalia, where most of the health facilities in the country are concentrated.MethodsA community-based health survey was carried out from 11 major towns in Somalia between October and December 2021. A structured and pretested questionnaire was used to collect data from 430 women who gave birth last five years. A logistic regression analysis was carried out to establish the association between the covariates of interest and the outcome variable.ResultsThe overall prevalence of institutional delivery was 57%. Approximately 38% of women who live in Mogadishu and 53% of women living in another ten towns give birth at home. Women who had a poor knowledge of the importance of health facility delivery had nearly four times higher odds of delivering at home (OR 3.645 CI: 1.488-8.928). Similarly, those who did not receive antenatal care (OR 2.551, CI: 1.017-6.399), and those who did not receive a consultation on the place of delivery (OR 2.145, CI: 1.167-3.942) were more likely to give birth at home. The reasons for home delivery included financial reasons, must use transport to reach the nearest health facility and it is easier to deliver at home.ConclusionThe study shows that home delivery is high in major towns in Somalia. It is important for health providers to communicate with women and men about the risks related to pregnancy and educate them about the importance of a health facility delivery. Antenatal care should be considered universal for pregnant women, while central and federal governments should guarantee access to free and within-reach ANC for women and girls. In conflict settings in Somalia, this should be done by training community health workers and auxiliary nurses who provide ANC for women through home visits.
Background/ObjectivesVitiligo is an immune‐mediated skin disorder that targets epidermal melanocytes leading to the appearance of depigmented skin patches. Different treatment modalities have been reported with varied efficacy. We tried to evaluate the safety and efficacy of intralesional methotrexate in treating localized areas of vitiligo.MethodsThirty participants with localized patches of vitiligo were recruited. They were treated with intralesional injections of methotrexate every 2 weeks for a maximum of six sessions. At the end of the study, the degree of repigmentation was categorized into: excellent improvement (>75% repigmentation), good improvement (50%–75% repigmentation), fair improvement (25%–50% repigmentation) and poor improvement (<25% repigmentation).ResultsWe included 7 males (23.3%) and 23 females (76.7%). Their mean age was 33.6 ± 8.6 years. The duration of the disease ranged from 1 to 22 years. Four patients had a family history of vitiligo. At the end of the study, there was a highly statistically significant improvement (p < 0.001) after treatment regarding repigmentation.ConclusionsThis study showed that intralesional methotrexate is a safe and effective treatment option for patients with localized vitiligo lesions. Further studies on a larger scale are needed to evaluate the long‐term effects of treatment and detect the ideal dose to be injected.
Urethral prolapse in children is mostly seen in prepubertal African-American girls who are usually asymptomatic on presentation and often diagnosed incidentally. We present a symptomatic urethral prolapse in a 6-year-old girl with painless vaginal bleeding. The most important point in order to avoid delayed treatment in urethral prolapse is to be aware of this rare malformation and be suspect from patients with mass and vaginal bleeding.
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