Tag Archives: Delivery of Health Care

The concept concerned with all aspects of providing and distributing health services to a patient population.

Kelly E: Female genital mutilation

Current Opinion in Obstetrics & Gynecology. 2005 Oct; (17)5:490-494

Female genital mutilation

Kelly, Elizabeth; Hillard, Paula J Adams


Purpose of review: The purpose of this review is to aid the healthcare practitioner in caring for children, girls, and women who have undergone female genital mutilation or who are at risk for female genital mutilation.

Recent findings: The bulk of the literature published in the area of female genital mutilation over the past year addresses the laws, social needs, immigration status and assimilation of African women who immigrate into western countries. Clinicians continue to publish case reports of complications and the surgical management of type III female genital mutilation during labor. Additionally, as people continue to try to eliminate female genital mutilation through human rights campaigns and the legal system, they have also become increasingly aware that understanding the motives behind this traditional practice may be an avenue towards change.

Summary: The fundamental understanding of female genital mutilation will allow the clinician to address the emotional and physical needs of the children, girls, and women who have undergone this traditional practice or who are at risk for undergoing this practice. This understanding will allow the practitioner to individualize the history and physical examination, and to provide appropriate management with recognition and treatment of complications. Increased knowledge of the laws against female genital mutilation will allow the healthcare provider to educate and advise at-risk girls and women as well as their parents.

This article can be purchased in this LINK

Female genital mutilation: the role of health professionals in prevention, assessment, and management

BMJ. 2012;344:e1361

Female genital mutilation: the role of health professionals in prevention, assessment, and management

Simpson J, Robinson K, Creighton SM, Hodes D

Summary Points

Female genital mutilation (FGM) is a form of child abuse and is illegal in the UK. It is also a criminal offence to arrange (or try to arrange) FGM overseas for a UK national or permanent UK resident. FGM is prevalent in certain UK minority and ethnic communities and health professionals should be aware of its likelihood within their patient populations. Health professionals must identify the local services available for women seeking help and children at risk. Training is essential so that health professionals can raise the matter with women sensitively and advise families on the UK legal position. All pregnant women from practising communities must be asked about FGM at routine antenatal booking; systems should be in place for this information to feed back

This article can be accessed in this LINK

A case of vulval swelling secondary to female circumcision posing a diagnostic dilemma.

Int J Surg Case Rep. 2012;3(9):431-4. Epub 2012 May 24.

A case of vulval swelling secondary to female circumcision posing a diagnostic dilemma.

Amu OC, Udeh EI, Ugochukwu AI, Madu C, Nzegwu MA.

Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria.

INTRODUCTION: The practice of FGM is most prevalent in the African countries such as Nigeria, Ethiopia, Sudan, Egypt, and some area of the Middle East. It is not restricted to any ethnic, religious or socioeconomic class. There are many reasons for perpetuation of this practice; the most common are cultural and religious beliefs. The aim of this paper is to highlight the diagnostic dilemma associated with this type of case and the psychological trauma of a patient following her unfortunate genital mutilations.

PRESENTATION OF CASE: We present the case of epidermal inclusion dermoid cyst in an 18-year-old teenage girl referred to us from the gynecologist as a case of hydrocoele of the canal of Nuck involving the left labia majora. Patient was previously seen by general practitioner who diagnosed a left Bartholins cyst. Excision of the mass, revealed a well encapsulated cystic mass containing serous fluid with no extension to the inguinal area, measured 10cm×8cm. Histology showed epidermoid inclusion dermoid cyst probably related to circumcision (female genital mutilation).

DISCUSSION: Implantation dermoid cyst though a recognized complication of FGM is rare in our environment and a high index of suspicion is required any time a girl presents with a vulval swelling. Cosmesis still remains the watchword to assuage the psychological impact on the patient.

CONCLUSION: There is need for more public health campaigns to educate communities about the harms of circumcision with the goal of eradicating the practice.

This article can be accessed in this LINK

Urinary catheterization and female genital mutilation.

CMAJ. 2012 Jun 18. [Epub ahead of print]

Urinary catheterization and female genital mutilation.

Rouzi AA.


A 30-year-old African woman was admitted in labour at 37 weeks’ gestation of her ifth pregnancy for emergency cesarean delivery. This was her irst assessment for the current pregnancy at this hospital. She had a cesarean delivery with each of her previous pregnancies. On examination, she was found to have type III female genital mutilation that had been done during childhood.

This article can be accessed in this LINK

A case study perspective on psychological outcomes after female genital mutilation.

J Obstet Gynaecol. 2012 Aug;32(6):560-5.

A case study perspective on psychological outcomes after female genital mutilation.

Pereda N, Arch M, Pérez-González A.

Grup de Recerca en Victimització Infantil i Adolescent (GReVIA) and Institute for Brain, Cognition and Behaviour (IR3C).


Female genital mutilation (FGM) is still performed throughout Africa and in a few countries of Asia and the Middle East, affecting over 100 million females worldwide. It includes procedures that intentionally injure female external genital organs for non-medical reasons, and can have deleterious consequences for the physical, psychological and sexual lives of its victims. This paper presents three case studies illustrating the psychological and sexual consequences of FGM. Data were gathered about child and family history, employment, medical and psychiatric history, and the genital mutilation experienced. Self-report measures of self-esteem, mental health status and sexual life were also administered. The results obtained highlight the need for European professionals to develop greater knowledge about FGM and its serious consequences, especially as regards sexuality. This is particularly important given the large numbers of immigrant women now residing within EU countries.

This article can be purchased in this LINK

Dissecting room: An enlightening guide to the health-care needs of Muslims

Lancet. 2001 july;358(9256):159

Dissecting room: An enlightening guide to the health-care needs of Muslims

Gamal I Serour

Caring for Muslim Patients
Aziz Sheikh, Abdul Rashid Gatrad
London: Radcliffe Medical Press, 2000
Pp 140. £17.95 ISBN-1857753720


…The hallmarks of this exploration of the interface between faith and health, are a restrained tone and a balance of topics and opinions. However, when the authors deal with certain practices such as female genital mutilation and contraception, they do not differentiate practices that relate to customs, tradition, and certain regional cultures from those that relate to Islamic instructions that should be followed by all observant Muslims, namely Sharia. I believe that when dealing with these controversial issues the authors should have emphasised the proper stance of Islam on these subjects. Doing so would enable health professionals in the UK and Europe to enlighten and inform their patients of what should be done when they are consulted by their patients and to dispel misconceptions about Islamic Sharia on these issues. This information would enable health professionals to provide the best medical service that conforms to the correct and documented beliefs of their Muslim patients…

This article can be accessed in this LINK

Female genital mutilation and the responsibility of reproductive health professionals

Female genital mutilation and the responsibility of reproductive health professionals

Toubia N

Global Action Against FGM Project, P.O. Box 1554, Cooper Station, New York, NY 10276, USA


No abstract is available for this article.

This article can be purchased in this LINK.

Strengthening the emergency healthcare system for mothers and children in The Gambia.

Reprod Health. 2010 Aug 18;7:21.

Strengthening the emergency healthcare system for mothers and children in The Gambia.

Cole-Ceesay R, Cherian M, Sonko A, Shivute N, Cham M, Davis M, Fatty F, Wieteska S, Baro M, Watson D, Phillips B, Macdonald R, Hayden B, Southall D.

Head Office, Maternal and Childhealth Advocacy International (MCAI), Conway Chambers, 83 Derby Rd, Nottingham NG1 5BB, UK. director@mcai.org.uk.

ABSTRACT: A system to improve the management of emergencies during pregnancy, childbirth, infancy and childhood in a region of The Gambia (Brikama) with a population of approximately 250,000 has been developed.This was accomplished through formal partnership between the Gambian Ministry of Health, the World Health Organisation, Maternal Childhealth Advocacy International and the Advanced Life Support Group.Since October 2006, the hospital in Brikama has been renovated and equipped and more efficiently provided with emergency medicines. An emergency ambulance service now links the community with the hospital through a mobile telephone system. Health professionals from community to hospital have been trained in obstetric, neonatal and paediatric emergency management using skills’ based education. The programme was evaluated in log books detailing individual resuscitations and by external assessment.The hospital now has constant water and electricity, a functioning operating theatre and emergency room; the maternity unit and children’s wards have better emergency equipment and there is a more reliable supply of oxygen and emergency drugs, including misoprostol (for treating post partum haemorrhage) and magnesium sulphate (for severe pre-eclampsia). There is also a blood transfusion service.Countrywide, 217 doctors, nurses, and midwives have undergone accredited training in the provision of emergency maternal, newborn and child care, including for major trauma. 33 have received additional education through Generic Instructor Courses and 15 have reached full instructor status. 83 Traditional Birth Attendants and 48 Village Health Workers have been trained in the recognition and initial management of emergencies, including resuscitation of the newborn. Eleven and ten nurses underwent training in peri-operative nursing and anaesthetics respectively, to address the acute shortage required for emergency Caesarean section.Between May 2007 and March 2010, 109 patients, mostly pregnant mothers, were stabilised and transported to hospital by the new emergency ambulance service.293 resuscitation attempts were documented in personal logbooks.A sustainable system for better managing emergencies has been established and is helping to negate the main obstacle impeding progress: the country’s lack of available trained medical and nursing staff. However, insufficient attention was paid to improving staff morale and accommodation representing significant failings of the programme.

This article can be accessed in this LINK.

Trends in the prevalence of female genital mutilation and its effect on delivery outcomes in the kassena-nankana district of northern Ghana.

Ghana Med J. 2006 Sep;40(3):87-92.

Trends in the prevalence of female genital mutilation and its effect on delivery outcomes in the kassena-nankana district of northern Ghana.

Oduro A, Ansah P, Hodgson A, Afful T, Baiden F, Adongo P, Koram K.

Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana.


RATIONAL: Female genital mutilation (FGM) is prevalent in northern Ghana, as the practice is seen as a passage rite to women adulthood and thus undertaken just before marriage.

OBJECTIVES: We determined the changes in trend of FGM in deliveries at the Navrongo War Memorial hospital, and compared the outcomes and FGM status.

DESIGN: Retrospective extraction and analysis of delivery data at the hospital from 1(st) January 1996 to 31(st) December 2003.

RESULTS: Of the 5071 deliveries, about 29% (1466/5071) were associated with FGM. The highest prevalence (95% CI) of 61.5% (50.9, 71.2) was in women aged 40 years and above, and the lowest of 14.4% (11.7, 17.0) was in women below 20 years. The all-age prevalence of FGM showed a significant decline (p-value for linear trend < 0.01) from 35.2% in 1996 to 21.1% in 2003. About 6% (89/1466) of mothers with FGM had stillbirths compared with about 3% (123/3605) of mothers without FGM. Again FGM was associated with 8.2% (120/1466) caesarean section rate compared with 6.7% (241/3605) in mothers without FGM. Mean birth weight and frequency of low birth weights were not significantly associated with FGM status.

CONCLUSION: Although there is a high rate of FGM among mothers in the district and is associated with a higher proportion of stillbirths and caesarean sections, practice has shown a significant decline in the district in recent years due to the prevailing campaigns and intervention studies. There is therefore the need to sustain the ongoing intervention efforts.

This article can be accessed in this LINK

Pregnancy and Complex Social Factors: A Model for Service Provision for Pregnant Women with Complex Social Factors.

Pregnancy and Complex Social Factors: A Model for Service Provision for Pregnant Women with Complex Social Factors.

National Collaborating Centre for Women’s and Children’s Health (UK). London: RCOG Press; 2010 Sep. National Institute for Health and Clinical Excellence: Guidance .

This guideline aims to: identify and describe best practice for service organisation and delivery that will improve access, acceptability and use of services; identify and describe services that encourage, overcome barriers to and facilitate the maintenance of contact throughout pregnancy; describe additional consultations with and/or support and information for women with complex social factors, and their partners and families, that should be provided during pregnancy, over and above that described in the NICE guideline ‘Antenatal care: routine care for the healthy pregnant woman’ (2008) (clinical guideline 62); identify when additional midwifery care or referral to other members of the maternity team (obstetricians and other specialists) would be appropriate, and what that additional care should be.

This guideline can be accessed online in this LINK