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

Prevalence Of Chlamydia Health And Social Care Essay

As before stated, chlamydia is the most prevailing sexually transmitted infection in the United States and is an of import public wellness issue. As a soundless infection with serious effects for adult females, forestalling the incidence of chlamydia is an of import issue for nurses advancing adolescent wellness and those who encounter sterility and ectopic gestation in their pattern ( Stewart & A ; Sparrow Center, 2005 ) . It is estimated that there are three million new infections each twelvemonth ( Adderley-Kelly & A ; Stephens, 2005 ) . Numerous prevalence surveies in assorted clinic populations have shown that sexually active striplings have higher rates of Chlamydia infections ( Adderley-Kelly & A ; Stephens, 2005 ) . In measuring and placing chlamydia infections quickly, the effects of wellness results will be decreased. This survey intends to look into whether or non early testing consequences to the bar and early sensing of chlamydia among immature adult females aged 13 to 25. In order to steer the proposed research inquiries of this survey, this literature reappraisal discusses important surveies and research that have been undertaken in relation to testing for chlamydia infection. Prevalence of Chlamydia Chlamydia is the universe ‘s most normally reported sexually transmitted infection ( STI ) ( World Health Organization [ WHO ] , 2009 ) . Its effects particularly to adult females are particularly serious: pelvic inflammatory diseases, ectopic gestation, and sterility. A greater concern among wellness attention practicians is the fact that chlamydia is mostly symptomless hence, testing becomes important in observing instances in order to cut down prevalence and the hazard of complications. the addition rates of chlamydia. Meyers, Halverson, & A ; Luckhaupt ( 2007 ) stated that if left undiagnosed and untreated, chlamydia airss several negative wellness results for pregnant every bit good as non-pregnant adult females. Complications originating from chlamydia could include PID, sterility, chronic pelvic hurting among non-pregnant adult females, chorioamnionitis, pre-term labour, premature rupture of membranes, preterm bringing, self-generated abortion, endometritis, and low birth weight in pregnant adult females. Harmonizing to the CDC ‘s Sexually Transmitted Disease Surveillance Annual Report in 2007, chlamydia prevalence is increasing because of a figure of hazard factors. This is particularly true among the younger populations of adult females. CDC ( 2007 ) stresses that the usage of hazardous sexual behaviours, usage of non-barrier contraceptive method, deficiency of instruction, and deficiency of testing contribute to the intensifying rates of chlamydia infection. Furthermore, several barriers lead to proper proving and diagnosing among sexually active immature adult females. Adolescents are loath to seek out proving or care on their sexual wellness because of ignorance, deficiency of consciousness, deficiency of clip, deficiency of transit to the clinics, and vacillation to be unfastened about sexual wellness issues. These barriers, harmonizing to the CDC ( 2007 ) , must be taken down for any intercession plan to win in cut downing chlamydia prevalent rates. Importance of Screening Central to the attempt in cut downing chlamydia prevalence is proper showing of bad populations such as immature adult females aged less than 25 old ages old ( Alexander, 2006 ) . The function of doctors and nursing professionals are important because they are in an first-class place to supply showing, hazard appraisal, and intervention every bit good as provide guidance and instruction plans to forestall infection. Literature has besides suggested that testing reduces the hazard of chlamydia infection among sexually active immature adult females. Recommendations for one-year showing for chlamydia among sexually active females has been a top precedence of the CDC beginning 1993. A survey by Fiscus et Al. ( 2004 ) examined the rate of testing experienced by sexually active females. In a nationally-implemented longitudinal survey of misss belonging in classs 7 until 12 all across the United States, Fiscus and co-workers obtained site-of-care studies, proving studies, studies for intervention to find how many of sexually experience immature misss received one-year showing as recommended by the CDC. A sum of 3,987 sexually active immature misss were participants to Beckon 1 of the alleged National Longitudinal Study of Adolescent Health. The survey found that testing among sexually active immature misss was unequal and may be a major lending factors to the lifting degrees of chlamydia incidence among adolescent misss. A clinical survey conducted by Nelson and Helfand ( 2001 ) aimed to analyze the effectivity of testing for the bar of Chlamydia infection. This survey was conducted in visible radiation of the recommendation made by the U. S. Preventive Services Task Force to implement testing in order to forestall the incidence of Chlamydia infection. A big population of male and female participants served as the survey ‘s sample. Questionnaires were mailed and included inquiries on demographic features and designation of a figure of hazard factors such as multiple sex spouses, non-use of barrier contraceptive method or rubbers, and old history of STD infection. The survey conclude that showing is an effectual signifier of intercession to cut down chlamydia infection among bad groups peculiarly pregnant and non-pregnant adult females. Mertz et al. , ( 2001 ) conducted a non-experimental and retrospective survey to measure the grounds behind high incidence of economically disadvantage immature misss with ages 16 to 24 old ages populating in an urban country. The survey concluded that hazardous sexual behaviour ( for economic grounds ) , multiple sex spouses and non-use of rubbers are behind the 10 % incidence of chlamydia infection among the group of immature adult females. Furthermore, deficiency of entree or non-affordability of trials besides hindered immature adult females to take attention of their sexual wellness. Scholes et Al. ( 2006 ) conducted an experimental survey utilizing randomized control test design to measure whether showing is an effectual scheme to cut down incidence of Chlamydia infection. The showing scheme proposed included the designation, proving, and intervention of adult females identified to belong to bad groups. Intervention plans such as proviso of rubbers, instruction and consciousness, and sexual wellness focal point group treatments were used. Women participants were sexually active females aged below 26 old ages old and adult females aged more than 26 and below 35 old ages old. After a 12-month follow up showing, it was found that chlamydia incidence decreased by 51 per centum. A reappraisal of literature conducted by Weinstock, Berman, and Cates ( 2004 ) suggested that proper and accurate monitoring of the prevalence of chlamydia infection among immature people was important in bar attempts. Weinstock and co-workers analyzed national instance studies, national studies, old literature reappraisals, and WHO datasets to analyze prevalence and place intercessions used. The writers identified several obstructions that hindered bar attempts. The major obstruction identified is the symptomless nature of the infection, which means that the disease can travel on without being detected. The writers recommended the execution of cosmopolitan testing plans to supervise and forestall the intensifying rates of STDs and STIs. A longitudinal survey implemented at a national degree from 2000 to 2001 by Ford, Jacard, Millstein, Bardsley, and Miller ( 2004 ) found that stripling ‘s perceptual experiences on their hazard of infection is extremely prognostic of their results in testing and intervention of chlamydia and gonorrhoea. The writers suggested that when striplings make accurate single hazard appraisals, they are more likely to prosecute wellness advancing behaviours such as contraceptive method and safe sex. Ford and his co-workers studied the relationship between demographic and wellness features to comprehend hazard of infection among two groups: 1 ) a sample of sexually active striplings with ages runing from 18 to 16 and 2 ) a subsample of striplings diagnosed with gonorrhoea of chlamydia. The survey found that merely 14 % of the entire respondents perceived they were at hazard for infection while more than 30 per centum of septic respondents reported sensed hazard. The writers suggested that instruction and awareness plans should be implemented to increase the truth of perceptual experiences of hazard among adolescent young person. A survey conducted by Karaer, Avsar, and Batioglu ( 2006 ) aimed to find the hazard factors that contribute to ectopic gestation, which is still a top factor for high maternal morbidity and mortality rates among pregnant adult females. The survey focused on placing hazard factors perceived to be a consequence of Chlamydia infections left untreated. Karaer and co-workers examined 225 instances and 375 control groups to look for commonalty in assorted demographic and behavioural features. Among the factors evaluated were demographic features, smoke, gynaecological history, surgical history, obstetric history, prophylactic use and aided gestation. The survey found that among other hazard factors, PID stood as the most of import for doing ectopic gestation. While the survey acknowledged deficiency of representativeness and deficiency of generalizability, the writers recommended that enhanced instruction and consciousness among adult females and the hazard factors could let an accurate an d timely diagnosing of ectopic gestation. A national longitudinal survey conducted by Crosby and Danner ( 2008 ) wanted to analyze how attitudes and beliefs among striplings were prognostic of geting STI or STD during early maturity. The survey hypothesized that the sexual wellness attitudes of striplings peculiarly refering STDs will foretell whether or non they will be infected with STD when they become grownups. This survey used informations from Wave 3 of the National Longitudinal Study of Adolescent Health and measure the prevalence of STDs such as gonorrhoea, Chlamydia trachomatis, and Trichomonas vaginalia. In add-on, self-report steps were administered to 8,297 striplings who besides provided urine samples for analysis. Self-report steps indicated that there was a general deficiency of instruction and consciousness among striplings about STDs or STIs. Test consequences for STDs during early maturity suggested that those who had accurate perceptual experiences on sexual wellness issues were less likely to contract STD . The findings suggest that supplying striplings with instruction and greater consciousness will most likely avert STD infection in the old ages to come. In a survey on the effectivity of testing among Norwegians, Skjeldestad, Marsico, Sings, Nordbo, and Storvold ( 2009 ) conducted a longitudinal cohort survey that started in December 2007 and ended in April 2009. The survey wanted to place hazard factors associated with repetition chlamydia infection among adult females aged 24 old ages and younger. A sample of 898 Norse adult females participated in the survey. Data aggregation used questionnaires, urine samples for chlamydia testing and needed clinical signifiers, medical records, and other pertinent paperss. Participants were tested for inclusion, and tested once more as a followup. The writers were able to reason that the major cause of reinfection among Norse adult females was a old chlamydia infection. Furthermore, rubber usage during intercourse besides revealed to be a hindrance for reinfection among adult females ( Skjeldestad, 2009 ) .DrumheadThe surveies examined for this literature reappraisal revealed that chlamydia is a serious wellness job among striplings and that showing as a agency of bar remains unequal. The reappraisal besides highlighted the hazard factors associated with chlamydia infection and reinfection. Factors identified include holding multiple sex spouses, old STD infection, and the non-use of rubbers or barrier contraceptive methods. Surveies reviewed here which aimed at measuring testing as a bar method for chlamydia used the longitudinal design and involved big samples. Urine trying seems to be the most prevailing method of proving for chlamydia. Restrictions of the surveies reviewed include non-representativeness and deficiency of control.

Continental Airlines: Flying High with Its Data Warehouse

The airline industry is a competitive market in which some airlines are profitable while others are not. During the late 1990s, most airlines were lucrative because fuel costs were relatively low and travel was at an all time high amongst flyers. Recently, the airline industry has taken a severe hit due to the increased rate of oil, the 9/11 attacks, and anti-traffic control system to name a few. However, Continental Airlines remains one of the largest airlines in the United States holding its rank in fourth place amongst other airline companies.Initially, Continental Airlines was not highly regarded because of its information technology (IT) and organizational culture. Unlike other airline companies, Continental Airlines has taken extreme measures by adopting new strategies to overhaul its IT department altogether. The information systems Continental had in place was old and outdated because it did not provide information of its most valuable customers. The Transaction Processing Fa cility (TPF) was the old IBM mainframe system Continental’s IT team had during the late 1990s. The system was not designed for customer service.In order for Continental to accomplish its goals, the IT team realized the need to replace its old mainframe. The IT team determined it needed to integrate into one system by consolidating the airline’s disparate customer management relationship (CRM) systems. As a result, Continental joined forces with Teradata to build an enterprise data warehouse comprised of 25 enterprise systems. The warehouses consist of â€Å"schedules, reservations, customer profiles and demographics, airline maintenance records and schedules, employee and crew payroll, and customer care† (Rainer & Turban, 2008, p.132).Additionally, executives of Continental Airlines were able to develop the Customer Value Metric (CVM), which enables them to determine how much money customers spend with its airlines and the costs of flying the customer as well. T he data warehouse is a repository of historical data that assist with business operations to include â€Å"data mining, decision support, and querying applications† (Rainer & Turban, 2008, p. 117). Many components make up the data warehouse such as business dimensions in which data is organized by customers, vendors, product, price level, and region.The data in various databases are encoded differently and kept historically for many years. Once data enters the warehouse it is not updated. Databases use online transaction processing (OLTP), in which business transactions are processed online as they occur. Typically, data warehouses are designed to support decision makers by using online analytical processing (OLAP) for the analysis of mass data by end users. Data is stored in a multidimensional structure as well. All data in the data warehouse comes from Continental Airlines operational databases which can be relational databases as well.These components enable users access t o corporate data for analyzing. Special software such as extract, transform, and load (ETL) are used to process data to later store in a data warehouse. However, only a summary of data is transferred to the warehouse. This data is organized in a form that is easy for end users when accessing. The reason why Continental Airlines remains successful is due to their strategies for improving and enhancing quality customer service with many functions implemented by their IT team.Continental Airlines main focus is increasing customer rewards and incentives of frequent flyers that are loyal customers, while gaining new customers that are profitable too. Continental Airlines contributes its success to the quality customer service and customer satisfaction it provides by expanding its routes and serving meals on every flight. Some airline companies have gone bankrupt while others simply choose not to improve their quality of customer service. As a result, customers have become irritated due t o the lack of reasonable rates, delays, and strict rules of other airline companies.In closing, information technology is essential for airline companies. Some airline companies may choose to stick with basic airline technology. However, an airline company can enhance its level of customer service and profitability based on the type of changes it needs to make. Executives of an airline company can look to its IT department to strategize ways to utilize information systems that best fits its goals, business practices, mission statement, customer service, and customer satisfaction.

Essay An Analysis of Orwells quot;Shooting an...

Shooting an Elephant is one of the most popular of George Orwells essays. Like his essays A hanging and How the Poor Die, it is chiefly autobiographical. It deals with his experience as a police-officer in Burma. After having completed his education, Orwell joined the Indian Imperial Police, and served in Burma, from 1922 to 1927, as an Assistant Superintendent of Police. His experiences as an officer in Burma were bitter. He was often a victim of the hostility and injustices at the hands of his colleagues and officers. Peter Stansky and William Abrahams in their book The Unknown Orwell write He was friendless and inexperienced, not certain of what to expect and fearful of proving to be inadequate, a predictable failure. Orwell†¦show more content†¦He appears to have recollected the incident very vividly just before he wrote the, but he had obviously been thinking of it intermittently ever since it happened. In Burmese Days, written several years before, the hero Flory, on his first meeting with Elizabeth Lackersteen, describes to her `the murder of an elephant, which he had perpetrated some years earlier. This essay reads like the leaves from the same Burmese notebooks, which Orwell used in writing his novel. It is frankly autobiographical and describes how an elephant went `must in a bazaar and killed a man. An Englishman was expected to rise to an occasion like this, so Orwell got the rifle and marched down to the field where the elephant had gone. As soon as he saw it, he knew that it was unnecessary to kill it; the fit was over. Equally surely, he knew that he was going to shoot it. The crowd following him willed him to kill it. M.G. Nayar writes, This essay enables us to get a glimpse of the authors experiences in Burma where he was employed in the British Imperial Police (1922 - 1927). Orwell had already come to regard imperialism `as very largely a racket, and he knew he was ill-fitted for the role he was called upon to play. During this period of Imperial service a sense of guilt