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Journal ArticleDOI

Health Workers' Assessment of the Frequency of and Caring for Urinary and Fecal Incontinence among Female Victims of Sexual Violence in the Eastern Congo: An Exploratory Study

31 Mar 2015-Open Journal of Nursing (Scientific Research Publishing)-Vol. 5, Iss: 4, pp 354-360

TL;DR: Urinary and fecal incontinence due to urogenital or colorectal fistulas among women exposed to sexual violence is a common in the specified setting, but lack of systematic investigation and appropriate treatment means that the quality of life of the victims may be negatively affected.

AbstractBackground: Throughout the long war that the Democratic Republic of Congo (DRC) has endured, women and children have been depicted as the primary victims of widespread sexual violence. In some settings women have been raped in entire villages, with devastating physical and psychological consequences, which include sexually transmitted infections such as HIV, trauma and fistulas, as well as social isolation and involuntary pregnancies. The aim of this study was to assess the prevalent perceptions of health professionals on the magnitude of urine and/or fecal incontinence among assaulted women, caused by sexual violence, as well as the opinions regarding the type of care provided to affected women. Methods: The study was part of a larger pilot study that had a cross-sectional design and a descriptive approach, which explored health professionals’ views regarding their own levels of competence at responding to the health needs of victims of sexual violence, in the form of a semi-structured questionnaire. Results: 104 health workers responded to the questionnaire. Nurses reported seeing raped women more frequently on a day-to-day basis (69.2%), in comparison to medical doctors and social workers (11.5%). Urinary incontinence was common according to 79% of health workers, who estimated that up to 15% of the women affected experienced huge amounts of urine leakage. Only 30% of the care seekers underwent in depth investigations, but the majority of the victims were not offered any further examination or appropriate treatments. Conclusion: Urinary and fecal incontinence due to urogenital or colorectal fistulas among women exposed to sexual violence is a common in the specified setting, but lack of systematic investigation and appropriate treatment means that the quality of life of the victims may be negatively affected. An improvement in the ability of health workers to manage these complex diagnoses is urgently needed, as well as adequately equipping health services in the affected settings.

Topics: Sexual violence (57%), Urinary incontinence (54%)

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Citations
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Journal ArticleDOI
TL;DR: The results indicated that nurses are critical professionals in caring for victims of sexual violence, that they see these women more than any other professional category, however, they are more likely than other categories to report being incompetent.
Abstract: The aim of this study was to assess health professionals’ opinions of their competence levels in responding to health needs of victims of sexual violence. This study used a cross-sectional design with a descriptive approach. A total of 104 physicians, nurses and social workers participated in the study. The data was collected using a questionnaire consisting of open and close-ended questions. Overall, 75% of the respondents were university graduates, but only a quarter of them felt they have adequate competence to care for these women; 36% had difficulties with general health assessment of assaulted women. The results indicated that nurses are critical professionals in caring for victims of sexual violence, that they see these women more than any other professional category. However, they are more likely than other categories to report being incompetent. Access to continued education was difficult, and more so for clinically-oriented health professionals than for others social professionals. Human resources capacity strengthening and particularly that of nurses will be the key investment in addressing assaulted women’s health needs in this region. Clinical researchers are called to identify rapid methods to reinforce nurses’ capacity and role in such a context with deprived health systems.

3 citations


Cites background from "Health Workers' Assessment of the F..."

  • ...Some results have been published elsewhere.[12] The questionnaire consisted of a total of thirty-five questions....

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Journal ArticleDOI
07 May 2018
TL;DR: This research examines the impact of sexual violence in the Eastern part of the Congo on the lives of women and finds that women in the region are more likely to be victims of gender-based violence than the general population.
Abstract: Background: The impact of sexual violence in any community is extremely devastating and women in the Eastern part of the Congo are no exception. Sexual violence not only affects the health of women ...

1 citations


References
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Book ChapterDOI
01 Jan 2008
TL;DR: This article is reproduced from the previous edition, volume 3, pp. 59–71, of Elsevier Inc.
Abstract: Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries, and risk factors are generally incomplete, fragmented, and of uncertain reliability and comparability. The Global Burden of Disease (GBD) Study has provided a conceptual and methodological framework to quantify and compare the health of populations using a summary measure of both mortality and disability, the disability-adjusted life year (DALY). This article describes key features of the Global Burden of Disease analytic approach, the evolution of the GBD starting from the first study for the year 1990, and summarizes the methodological improvements incorporated into GBD revisions carried out by the World Health Organization. It also reviews controversies and criticisms, and examines priorities and issues for future GBD updates.

983 citations


Journal ArticleDOI
TL;DR: The conflict in the Democratic Republic of Congo remains the world's deadliest humanitarian crisis and improvements in security and increased humanitarian assistance are urgently needed.
Abstract: Findings 19 500 households were visited. The national crude mortality rate of 2·1 deaths per 1000 per month (95% CI 1·6–2·6) was 40% higher than the sub-Saharan regional level (1·5), corresponding to 600 000 more deaths than would be expected during the recall period and 38 000 excess deaths per month. Total death toll from the conflict (1998–2004) was estimated to be 3·9 million. Mortality rate was higher in unstable eastern provinces, showing the effect of insecurity. Most deaths were from easily preventable and treatable illnesses rather than violence. Regression analysis suggested that if the effects of violence were removed, all-cause mortality could fall to almost normal rates. Interpretation The conflict in the Democratic Republic of Congo remains the world’s deadliest humanitarian crisis. To save lives, improvements in security and increased humanitarian assistance are urgently needed.

417 citations


"Health Workers' Assessment of the F..." refers background in this paper

  • ...This war has been labeled “the forgotten holocaust” [1] owing to the fact that approximately 8 million people have been killed [2] and as many as 5 million people displaced [1]....

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Journal ArticleDOI
TL;DR: Mixed methods findings show rape survivors were seen as "contaminated with HIV, contributing to their isolation and over 95% could not access prophylactic care in time, and receiving support from their husbands after rape was protective against survivors' feelings of shame and social isolation.
Abstract: The conflict in eastern Democratic Republic of the Congo (DRC) is the deadliest since World War II. Over a decade of fighting amongst an array of armed groups has resulted in extensive human rights abuses, particularly the widespread use of sexual violence against women. Using a mixed-methods approach, we surveyed a non-random sample of 255 women attending a referral hospital and two local non-governmental organizations to characterize their experiences of sexual and gender-based violence (SGBV). We then conducted focus groups of 48 women survivors of SGBV to elaborate on survey findings. Quantitative and qualitative data underwent thematic and statistical analysis respectively. Of the women surveyed, 193 (75.7%) experienced rape. Twenty-nine percent of raped women were rejected by their families and 6% by their communities. Thirteen percent of women had a child from rape. Widowhood, husband abandonment, gang rape, and having a child from rape were significant risk factors for social rejection. Mixed methods findings show rape survivors were seen as "contaminated" with HIV, contributing to their isolation and over 95% could not access prophylactic care in time. Receiving support from their husbands after rape was protective against survivors' feelings of shame and social isolation. Rape results not only in physical and psychological trauma, but can destroy family and community structures. Women face significant obstacles in seeking services after rape. Interventions offering long-term solutions for hyper-vulnerable women are vital, but lacking; reintegration programs on SGBV for women, men, and communities are also needed.

95 citations


"Health Workers' Assessment of the F..." refers background in this paper

  • ...This high prevalence has devastating consequences for the individuals, such as, hygiene problems, humiliation, sadness and often even rejection and divorce as a result as well as social isolation [7] [11]....

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Journal ArticleDOI
TL;DR: It is documented that in the DRC conflict sexual violence has been – and continues to be – highly prevalent in a wide area in the East of the country.
Abstract: Background Despite international acknowledgement of the linkages between sexual violence and conflict, reliable data on its prevalence, the circumstances, characteristics of perpetrators, and physical or mental health impacts is rare. Among the conflicts that have been associated with widespread sexual violence has been the one in the Democratic Republic of the Congo (DRC).

91 citations


"Health Workers' Assessment of the F..." refers background in this paper

  • ...Despite the overwhelming devastating incidence of sexual violence in DRC there are only a limited number of published studies, which overwhelmingly focus on clinical management and care issues, including the management of fistulas and social psychological aspects [3] [9]....

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Journal ArticleDOI
TL;DR: A coordinated effort amongst key stakeholders to secure peace and stability, an increase in humanitarian assistance and the rebuilding of the infrastructure, human and physical resources, and medical, educational and judicial systems are recommended.
Abstract: The Eastern region of the Democratic Republic of Congo (DRC) is currently undergoing a brutal war. Armed groups from the DRC and neighbouring countries are committing atrocities and systematically using sexual violence as a weapon of war to humiliate, intimidate and dominate women, girls, their men and communities. Armed combatants take advantage with impunity, knowing they will not be held to account or pursued by police or judicial authorities. A particularly inhumane public health problem has emerged: traumatic gynaecological fistula and genital injury from brutal sexual violence and gang-rape, along with enormous psychosocial and emotional burdens. Many of the women who survive find themselves pregnant or infected with STIs/HIV with no access to treatment. This report was compiled at the Doctors on Call for Service/Heal Africa Hospital in Goma, Eastern Congo, from the cases of 4,715 women and girls who suffered sexual violence between April 2003 and June 2006, of whom 702 had genital fistula. It presents the personal experiences of seven survivors whose injuries were severe and long-term, with life-changing effects. The paper recommends a coordinated effort amongst key stakeholders to secure peace and stability, an increase in humanitarian assistance and the rebuilding of the infrastructure, human and physical resources, and medical, educational and judicial systems.

82 citations


"Health Workers' Assessment of the F..." refers background or methods in this paper

  • ...A figure that may have been underestimated, as Longombe (2008) found in a period between April 2003 to June 2006 that out of a group of 4715 women and girls who had been exposed to sexual violence, 702 (15%) had genital fistulas [3]....

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  • ...Despite the overwhelming devastating incidence of sexual violence in DRC there are only a limited number of published studies, which overwhelmingly focus on clinical management and care issues, including the management of fistulas and social psychological aspects [3] [9]....

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  • ...Studies have reported that about 5 - 15 percent of the women experienced fistulas [3] [10], approximately one out of every 10 raped victims....

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  • ...Brutality and sexual violence have been strategically used as weapons in order to break down entire communities [3] [4]....

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