Hrvatin I1, Šćepanović D11University Medical Center Ljubljana, Gynaecological Clinic, Ljubljana, SloveniaBackground: FGM represents a global concern as 63 million more girls could be subjected to FGM by 2050. It is a deeply embedded cultural tradition that holds a symbolic meaning in numerous communities and is practiced in rural and urban areas. While the exact number of girls and women worldwide who have undergone FGM procedure remains unknown, at least 200 million girls and women in 30 countries have been subjected to the practice. The practice of FGM is highly concentrated in Africa, in the Middle East and in some Asian countries, but can also be found in Europe, Australia and North America, due to displacement caused by civil wars, globalization and migration.Purpose: The objective of this paper was to review the current literature on female genital mutilation and its consequences, to describe and critically assess the theoretical and methodological approaches to treatment options and to describe and assess different methods that aim to stop or reduce the continuation of FGM.Methods: We carried out a literature review of articles published in the last 10 years. Included articles studied consequences following FGM, treatment options and different methods to stop or reduce the continuation of FGM. Literature search was conducted on the following databases PubMed, PEDro, Cochrane database, CINAHL and Medline.Results: Globally the prevalence is declining, as many actions from legal to community based programmes are being proposed. There are many known consequences that can be divided in to two groups: short and long term. Treatment options are well documented in the literature, but published studies are of poor quality. Nevertheless, there are many treatment options and guidelines on how to treat women with FGM. Health care professional should be well informed and sensitive to properly treat women with FGM. They should also inform women about possible consequences and legal aspects. Recent literature review of student's and health care professionals' knowledge and attitudes regarding FGM showed that there is a strong need for education and training, since health care professionals are the key persons in the care for complications and prevention of FGM. Studies show that there is a huge lack of knowledge regarding this subject. Society should be informed about this procedure and should encourage open communication within the society, especially between men and women, since their opinion usually matches, but because the lack of communication in the community the practice continues.Conclusion(s): This article offers a new and recent prospective of FGM, consequences and treatment options as well as what we can do to stop this practice. Limitations of this review include the risk of bias, because it is not possible to identify and retrieve all studies. Future research should be of better quality and should focus especially on treatment options.Implications: As health care professionals we should have some knowledge of the subject and especially about how to address and inform possible future patients that have been submitted to the practice.Keywords: female genital mutilation, consequences, preventionFunding acknowledgements: This study was unfunded.Topic: Women's & men's pelvic health; Globalisation: health systems, policies & strategies; Professional practice: otherEthics approval required: NoInstitution: NoneEthics committee: NoneReason not required: This was a literature review, therefore ethics approval was not needed.All authors, affiliations and abstracts have been published as submitted.
BACKGROUND: Female genital mutilation (FGM) and its impact on women's health are becoming relevant in Australia due to increases in numbers of refugees and migrants from affected countries. Notwithstanding the psychological trauma from FGM, there is a broad range of sequelae relevant to obstetrics and gynaecology, particularly related to maternal morbidity from labour and delivery. AIMS: To assess the prevalence of FGM in our unit and document its effect on maternal and neonatal outcomes. METHODS: Retrospective cohort study of women affected by FGM who delivered at a metropolitan hospital in Sydney over a five-year period. The primary outcome was mode of delivery and secondary outcomes addressed maternal morbidity and neonatal nursery admission compared with women unaffected by FGM. RESULTS: A full data set was available for 141/142 women affected by FGM. The overall prevalence of FGM was 1.64%. The majority of women affected by FGM were documented to have FGM 3 (41.1%). There was no difference in caesarean section rate. Women with FGM were less likely to be delivered by vacuum or forceps (11.1% vs 2.8%; P = 0.0009). There was no difference in perineal trauma, postpartum haemorrhage and neonatal nursery admission. Women with FGM 3 were more likely to have an episiotomy (4.8% vs 25.9%; P = 0.0007) without an increase in anal sphincter injury (P = 0.7). Documentation complying with local policy and guidelines was poor. CONCLUSIONS: FGM is increasingly common in Australia. This study adds to the Australian literature quantifying the effects on obstetric outcomes in these high-risk women.
Female genital mutilation (FGM) refers to all procedures that partially or totally remove the external female genitalia, or to all other deliberate injuries to the female genital organs for non-medical reasons. It is thought that over 200 million girls and women have had some form of FGM, with more than three million girls being at risk annually. The procedure varies in severity from partial or complete removal of the clitoris (Type 1) to oversewing of the vaginal opening, so-called infibulation (Type 3). There are no medical benefits from FGM, with complications increasing with the amount of tissue damage that has been inflicted. Side effects may be psychological and physical including excessive scarring, pain, infections, sexual dysfunction with significant obstetrical complications such as fistulas and increased risks of stillbirth, as well as increased neonatal and maternal morbidity and mortality. Although primarily originating in countries in Africa, the Middle East and Asia, mass migrations in recent years have made FGM a feature in most societies. For this reason, forensic practitioners and pathologists should be aware of the anatomical features of FGM and the potential medical and psychological side effects. Accurate recording of cases is required to enable appropriate resources to be allocated for instituting preventive measures.
Female genital mutilation/cutting (FGM/C) is a dangerous practice that predates all religions and perpetrated on children for various reasons in various cultural and global contexts, causing adverse lifelong health consequences including sexual, physical and psychological problems for the survivors. Even so, there appears to be no documented work that brings together the major conceptual blocks on FGM/C, a gap this paper seeks to begin to fill. This paper summarises some major concepts on FGM/C as a resource and evaluates key evidence on the practice. While the practice of FGM/C is highly concentrated in Africa, the practice is spread out globally with a shift towards its medicalization among migrant communities and traditional settings. A focus of this paper is to propagate awareness and polarise debates to bring to an end to the practice of FGM/C globally.
At the halfway mark for implementation of the Sustainable Development Agenda, progress towards achieving targets centred on child health and development has decelerated, impeding the survival and potential of many children. The Lancet Series on optimising child and adolescent health and development called for renewed efforts to nurture the health and development of all children.1 To accomplish this, it is necessary to expand implementation of evidence-based interventions that address factors jeopardising optimal outcomes, spanning from pre-conception into adulthood.
Abstract Despite large‐scale studies demonstrating the benefits of teacher interaction to support young children's learning, intentional teaching (IT) in early childhood education (ECE) remains a contested concept. Given the different perspectives associated with IT, the purpose of this study was to undertake a scoping review of the literature focused on IT in ECE. A systematic approach was adopted to map the evidence to identify key concepts, theories, sources and knowledge gaps. Such a review has the potential to assist researchers, practitioners and policy makers to make informed decisions about the different approaches to IT. The 101 items reviewed were selected according to the following criteria: investigated IT in some way; focused on learners aged birth to 8 years; made a conceptual contribution to understanding IT in ECE; full text availability, and published in English between 2010 and 2019, inclusive. The search incorporated a range of items including peer‐reviewed journal articles, research reports, professional journals, an unpublished thesis and books. Results foregrounded the difficulties involved in reconciling IT and child‐led learning through play, and that these difficulties were most fiercely experienced in the 3–5 age group. An overarching conclusion was that theoretical differences influenced how learning was understood, and determined which learning outcomes were articulated and measured. This review suggests that decisions about IT in ECE are dependent on how the purposes of ECE are defined in and through policy. Context and implication Rationale for this study: There appear to have been no systematic reviews of the concept of intentional teaching (IT) in early childhood education (ECE). This scoping literature review sought clarity about the nature and role of intentional teaching. It investigated issues about what, how and when IT is applicable for young children’s learning. Why the new findings matter: Intentional teaching in ECE is a contested concept despite large‐scale studies demonstrating the need for a balance between child‐led and teacher directed learning. This scoping review maps the evidence to identify key concepts, theories, sources and knowledge gaps. Implications for educational researchers and policy makers: This scoping review assists researchers, practitioners and policy makers to make informed decisions about the various approaches to IT. Decisions about IT were related to the purposes of ECE that were identified in policy, making policy influential. Theoretical perspectives framed how learning is understood and the role of educators in that learning. The disjuncture between IT and child‐led learning prevailed especially for children aged 3–5 years.
Susan Grieshaber, Susan Krieg, Felicity McArdle et al.
Research on professional learning communities (PLCs) in early childhood education (ECE) contexts is still relatively rare and little is known about how such communities can be established and embedded. This article reports findings from research into the sustainability of professional learning communities in New Zealand’s early childhood sector and in particular, what factors affected sustainability and how changes in teacher practices were supported. The study found enablers to the establishment and sustenance of PLC in the ECE sector to be: clear membership and effective induction for new members; a shared focus, commitment and research orientation; clarity of roles including leadership roles; opportunities for dialogue and deprivatisation of practice and stimulus of new ideas.
BACKGROUND: The condition known as 22q11 microdeletion syndrome has a broad phenotypic spectrum, with many affected individuals experiencing mild-to-moderate immunodeficiency. Currently, there are significant variations in live vaccine practices and immunological testing prior to live vaccine administration due to safety concerns and limited established guidelines. METHODS: Queensland Children's Hospital (QCH) Child Development Unit, offers a state-wide 22q11 microdeletion clinic. This is a retrospective single-centre review, capturing the majority of children with 22q11 microdeletion in Queensland, Australia. We describe the live vaccination status of 134 children, age 0 to 18 years under our care between 2000 and 2018, adverse events following immunisation (AEFI) and the proportion of children who received additional pneumococcal coverage. An immunological investigation pathway prior to live vaccine administration is proposed. RESULTS: Of the 134 children, 124 were eligible for live vaccinations as per the Australian National Immunisation Program: 82% had received dose one of measles, mumps and rubella (MMR) vaccine, 77% had completed MMR dose two and 66% had completed varicella immunisation. There were no AEFI notifications reported. Of the total sample of children, 18% received a fourth dose of conjugate pneumococcal vaccine (Prevenar 7 or 13) and 16% received a dose of Pneumovax 23 from 4 years of age. Immunology workup practices were demonstrated to vary widely prior to live vaccine administration. Most patients' immune profiles were consistent with mild-to-moderate immunodeficiency. CONCLUSION: We propose an immunological investigation and vaccination pathway with the aim of providing guidance and consistency to clinicians caring for children with 22q11 microdeletion.
Angela Berkhout, Kahn Preece, Vanil Varghese et al.
Routine vaccines are critical to child health. The COVID-19 pandemic significantly impacted essential health services, particularly in low-and middle-income countries (LMICs). We reviewed literature to determine the impact of COVID-19 on service delivery and uptake of routine childhood immunisation in LMICs. We reviewed papers published between March 2020 and June 2022 using a scoping review framework, and assessed each paper across the World Health Organisation health system strengthening framework. Our search identified 3,471 publications; 58 studies were included. One-quarter of studies showed routine childhood immunisation coverage declined (10% to 38%) between 2019 to 2021. Declines in the number of vaccine doses administered (25% to 51%), timeliness (6.2% to 34%), and the availability of fixed and outreach services were also reported. Strategies proposed to improve coverage included catch-up activities, strengthening supply chain and outreach services. Re-focusing efforts on increasing coverage is critical to improve child health and reduce the likelihood of disease outbreaks.
Milena Dalton, Benjamin Sanderson, Leanne J. Robinson et al.
OBJECTIVE: Vaccinations in Australia are reportable to the Australian Immunisation Register (AIR). Following major immunisation policy initiatives, the New South Wales (NSW) Public Health Network undertook an audit to estimate true immunisation coverage of NSW children at one year of age, and explore reasons associated with under-reporting. METHODS: Cross-sectional survey examining AIR immunisation records of a stratified random sample of 491 NSW children aged 12≤15 months at 30 September 2017 who were >30 days overdue for immunisation. Survey data were analysed using population weights. RESULTS: Estimated true coverage of fully vaccinated one-year-old children in NSW is 96.2% (CI:95.9-96.4), 2.1% higher than AIR reported coverage of 94.1%. Of the children reported as overdue on AIR, 34.9% (CI:30.9-38.9) were actually fully vaccinated. No significant association was found between under-reporting and socioeconomic status, rurality or reported local coverage level. Data errors in AIR uploading (at provider level) and duplicate records contributed to incorrect AIR coverage recording. CONCLUSIONS: Despite incentives to record childhood vaccinations on AIR, under-reporting continues to be an important contributor to underestimation of true coverage in NSW. Implications for public health: More reliable transmission of encounters to AIR at provider level and removal of duplicates would improve accuracy of reported coverage.
Charlee Law, Rhydwyn McGuire, Mark J Ferson et al.
