Transcript Incidence and Cases Treated by Country - UNFPA

Mapping Training in
Fistula Management:
An Overview of Capacities and Needs
Obstetric Fistula Working Group
Meeting on Training
Niamey, Niger – 19 to 20 April, 2005
Overview of Mapping Process
Objective: To provide an overview of current treatment and
training capacities and needs
Method:
 Questionnaire distributed to Working Group Members and to
countries via UNFPA country offices (completed by gov’t
ministries, NGOs, treatment facilities, and UNFPA)
– Questionnaires received from 13 countries:
Bangladesh, Benin, Burkina Faso, DRC, Eritrea, Kenya1,
Mauritania, Niger, Senegal, Sierra Leone, Sudan,
Tanzania2, Uganda2
 Review of available needs assessments and other sources for
other countries
1 2 received (UNFPA/AMREF),
2 Covers only AMREF supported facilities
Limitations:
 Lacks data from countries not already active in
the Campaign
 Lack of universal definitions made comparability
between countries difficult
 Data not available or routinely collected in many
countries
Incidence and Cases Treated by Country
Country
Estimated annual
incidence
Cases treated
annually
Benin
60*
44
Burkina Faso 131*
49
DRC
500
106
Ethiopia
8500
1200
Kenya
3000
225
Mali
600
195
Niger
1500
200
Nigeria
20,000
4,146
Sierra Leone
500
191
Sudan
1000
429
Tanzania
2000
1,000
Uganda
1000
400
Over 8,000 treated
Range of ~7% to
~73% repaired
(not really
comparable)
Data collection
noted as difficult
*reported cases
Country
Number of facilities
Bangladesh
12
Benin
3
Burkina Faso
3
Chad
4
DRC
14
Eritrea
3
Ethiopia
1 + outreach centres
Kenya
7
Mali
3
Mauritania
0
Niger
3
Nigeria
> 30?
Senegal
6
Sierra Leone
4
Sudan
8
Tanzania
11
Uganda
6
# of Facilities
Providing Treatment
by Country
 Range from 0 to >30
 4 facilities known to have
more than 300 cases
annually (Addis Ababa,
Katsina, Kano, Goma)
 2 known to have
approximately 250
(Bugando, Bamako)
Country
Number of Doctors
Bangladesh
20
Benin
2
Burkina Faso
6
Chad
6
DRC
7
Eritrea
3
Ethiopia
6 + 5 (many trained)
Kenya
7+
Mali
8 + 3 in training
Mauritania
0 (4 attempt)
Niger
6
Nigeria
? (many trained)
Senegal
15
Sierra Leone
2
Sudan
9
Tanzania
16
Uganda
5
# Nat’l Doctors Skilled
in Fistula Repair
 Masks varying levels of
skill and activity
 May include those trained
who do not actively repair
and some active although
not fully trained
 Includes varying
disciplines, ob/gyns,
urologists and general
surgeons
Characteristics of Repair Surgeons
 Many countries have few to no national surgeons that
can perform complicated repairs.
 The following countries mentioned:
– Kenya (5), Tanzania (5), Uganda (1), Chad (1-2),
Senegal (2), Mali (4?), Benin (2), DRC (4), Sudan
(7), Niger (4), Bangladesh (12), Nigeria (~15)
 Number of repairs performed often not listed, perhaps
not available
Types of training received
 Training at a fistula treatment centre (mostly reported at
Addis Ababa Fistula Hospital, Babbar Ruga Hospital,
Katsina, Dr. Abbo Centre, Khartoum, Dhaka Medical
College)
 Workshops (noted in Bangladesh, Kenya, Uganda and
Tanzania)
 On-the-job training by experts (expatriate & national)
 Self-trained through practice
 Post-graduate studies (urology/gynaecology)
Trainers
• The majority of the countries had at least one
trainer (8 of 13)
• Some countries still lack national capacity and
rely on expatriate expertise
# of OT and Ward Nurses skilled in
fistula care
Country
OT
Ward
Bangladesh
16
16
Eritrea
9
20
Kenya
10
10
Niger
10
8
Senegal
8
8
Sierra Leone
5
7
Tanzania
30
20
Uganda
10
10
Nigeria
 For many countries,
none trained or
information
unavailable
Social workers and Others
• Only 4 countries noted social workers trained in fistula:
Bangladesh (6), Niger (6), Senegal (1), Kenya (#
unknown), known that Nigeria and Mali have several
NGOs working in this area
• Other types of professionals noted (not specified in
questionnaire):
– Physiotherapists, 15 in 3 countries (all AMREF
facilities)
National Plans and Standards
• Countries with national or sub-national plans:
Bangladesh, Burkina Faso, Eritrea, Kenya, TZ, Uganda
• Countries with national plans for training: Bangladesh,
Eritrea, Kenya, TZ, Uganda
• Countries with national training standards: Bangladesh,
Senegal, Kenya, Uganda
National Curricula
• Countries with national training curricula for
treatment: Bangladesh, Sudan, Kenya (ongoing),
Uganda
• Countries with national training curricula for
counseling: Bangladesh, Sudan, Kenya
(ongoing, part of above effort)
Fistula in Medical Curricula
• Countries with fistula in the national medical
curricula: Bangladesh, Burkina Faso (not
sufficient), Sudan, Senegal, Mozambique, TZ
• Countries with fistula in post-graduate medical
curricula: Bangladesh, Kenya, Sudan, Senegal,
TZ
Types of Training Underway
• Surgeons and nurses learn on the job.
• Theoretical and practical workshops in national/regional
centres.
• Medical student rotations.
• Training workshops led by visiting specialists.
• Training workshops led by international universities, i.e.
Stanford in Eritrea.
• Workshops led by international/regional NGOs, i.e.
AMREF
• MOH funding a fistula centre for on the job training.
Training Needs
•
•
•
•
•
Doctors –from 4 to 100
Surgical nurses – from 4 to 200
Ward nurses – from 15 to 60
Social workers – from 40 to 300
Others – physiotherapists; anaesthetists
Training Gaps
•
•
•
•
•
•
In some cases, no official training underway.
Only urology training includes fistula.
NGOs bring experts but don’t train local doctors.
Critical shortage of health workers.
Only theoretical aspects taught.
Lack of space at regional training centres –
Addis, Katsina, etc.
Discussion Questions
• What are our realistic training goals? to train as
many as possible or a few motivated surgeons?
• How many repairs can a surgeon reasonably do
in a year? How many per prevalence or
incidence are needed?
• How many trainers are needed to meet this
need? Do we have enough already?
• Nurses, physiotherapists, social workers,
anaesthetists??
• Pre-service curricula – how much should it
include?