Management of sexual dysfunction following poorly healed episiotomy in a multipara in low-income setting

Background: Episiotomy describes an incision made on the perineum to widen the vaginal orifice so as to aid delivery of the baby. Though not routinely recommended, it is a common during delivery. Despite the intended positive outcomes, complications like sexual dysfunction, urinary incontinence, chronic pelvic pain, perineal infection do occur following it. When sexual dysfunction occurs as sequelae as a result of poor episiotomy repair technique or poor healing, it can affect sexual intercourse and lead to marital disharmony especially in societies that tend to lean towards patriarchy Case presentation: A 31-year-old Nigerian multiparous lady with three living children presented on account of complaints of lax introitus and lack of sexual satisfaction by the partner. She had poorly healed bilateral episiotomy scar following her last delivery. She has been practicing Kegel’s exercise with no improvement. There was associated threat to their relationship by her partner. Perineolasty and vaginoplasty was done. She had successful recovery and improvement in the quality of sex. Conclusion: This is a rare case of a woman in our clime visiting the clinic to request for perineal reconstruction following complaints by her partner and threat to their relationship. Obstetricians should pay attention to any complaint or worry following episiotomy and offer appropriate care to meet the sexuality needs of the parous following childbirth. Keywords: episiotomy; Kegel’s exercise; perineoplasty; vaginoplasty.

Training Needs Assessment of Health Care Professionals in Reproductive, Maternal and Newborn Health in a Low-Income Setting in Tanzania

Background: Healthcare delivery globally and particularly in low-income setting is challenged by multiple, complex and dynamic problems. The reproductive, maternal and newborn health (RMNH) care is among the most affected areas resulting into high maternal and neonatal mortality and morbidity across the Sub Saharan region and Tanzania in particular. However, under-investment in adequate training and capacity development among health care workers (HCWs) is reported worldwide and contributes to the critical shortages, and lack of adequate knowledge and skills among HCWs. The aim of this study was to assess the training needs among HCWs of RMNH care in selected health facilities of Mwanza, Tanzania. Methods: A cross-sectional descriptive and analytic survey using a self- administered questionnaire was conducted in 36 out of 80 health care facilities included in Improving Access to Reproductive, Maternal and Newborn Health in Mwanza, Tanzania (IMPACT) project within the 8 councils of Mwanza region in Tanzania. The training needs assessment (TNA) tool adapted from the Hennessy-Hicks’ Training Needs Assessment Questionnaire (TNAQ) was used for data collection. The HCWs rated on the importance of their task and their current performance of the task. The differences in scores were calculated to identify the greatest training needs.Results: Out of 153 HCWs who responded to the TNA questionnaire, majority were registered (n=62) and enrolled (n=43) nurses. Ninety percent (n= 137) were from government-owned health facilities, mostly from hospitals 68 (45%). Training needs were high in 16 areas (out of 49) including cervical cancer screening and care; accessing research resources; basic and comprehensive emergency obstetric and newborn care; and sexual and gender-based violence. The overall perceived importance of the training needs was significantly associated with perceived performance of tasks related to RMNH services (Pearson Correlation (r) = .256; p <001).Conclusions: The study highlights 16 (out of 49) training gaps as perceived by HCWs in RMNH in Tanzania. The utilization of findings from the TNA has great potential to facilitate designing of effective trainings for local RMNH services delivery hence improve the overall quality of care.

Practice of Oncology in Low- income Setting: A Review of Four Years Activities in Togo

Purpose: Until 2016, there was no oncologist in Togo. This study reviewed the first four years of activities in the practice of clinical oncology in the country to provide the cancer profile, the treatment, and outcomes of patients.Methods: We performed a retrospective descriptive study of patients diagnosed with cancer seen in oncology in Togo from March 2016 to March 2020. Data on presentation, staging, treatment, and outcomes were reviewed. Statistics were computed using SPSS.Results: A total of 897 patients were included. There were 625 women (69.7%) and 272 men (30.3%). The mean age at diagnosis was 53.48 years for men and 52.39 for women and more than half of patients were under 60 years. A cancer diagnosis was histologically confirmed in 81.2% of patients. For both sexes, breast cancer was the commonest followed by cervix cancer, colorectal cancer, prostate, and stomach cancer. In men, prostate cancer ranked first followed respectively by gastric cancer and colorectal cancer. The most common cancer in women was breast cancer followed by cervix cancer. Majority of patients (60%) presented at a late stage. 531 patients (59.2%) received at least one cancer therapy modality but more than half of treated patients did not complete their treatment. After fifty-eight months of follow-up, only 132 patients (14.7%) in the all-study population are alive. Conclusion: This study describes the epidemiology and oncologic treatment in Togolese patients. Breast and Prostate are the leading cancer diagnoses in our population. Most patients presented at an advanced stage and the treatment was palliative in a majority of patients. There is an urgent need for early detection of cancer in Togo.

Empagliflozin Use and Fournier’s Gangrene: Case Report and Systematic Literature Review

Background: Fournier’s gangrene (FG) is a rare necrotising soft tissue infection localised in the genital areas with possible dramatic outcomes. Recently, sodium glucose co-transporter-2 (SGLT2) inhibitors were identified as a risk factor. Methods: We present a case report of a 57-year-old female patient with type 2 diabetes mellitus (T2DM) in treatment with empagliflozin which led to the development of FG. Moreover, we performed a systematic review assessing the association between empagliflozin use and FG. Results: The female patient with 15-years treated diabetes presented a massive FG after 6 months from starting empagliflozin. Over the period of two months, she was successfully treated in a low-income setting. The systematic review included two studies with a total of 9915 participants. Although no participant had FG, there was an increased rate of urinary and genital infection in patients treated with empagliflozin compared to those treated with other antidiabetics or placebo. Conclusions: FG should be considered as a possible complication in patients using SGLT2. Patients should be educated to report early signs of genital infection and healthy behaviours as well as a balanced diet should be promoted to aid in the prevention of FG.