Health-related quality of life among women in rural Bangladesh after surgical repair of obstetric fistula

Quality of life and its predictive factors among women with obstetric fistula in Ethiopia: A cross-sectional study

Objective

Living with obstetric fistulas is detrimental to the quality of life of women with fistulas. This study aimed to assess the quality of life and predictive factors among women with obstetric fistula in Ethiopia.

Methods

A cross-sectional study was employed on consecutively selected 478 women. Linear regressions were used for data analysis.

Results

The mean quality of life in physical, psychological, social, and environmental health domains and the overall quality of life were 40.59 ± 1.58, 38.10 ± 1.78, 29.59 ± 1.97, 34.21 ± 1.65, and 44.61 ± 3.99 respectively. Repair outcome without urinary inconsistence (β = 5.2; 95% CI = 0.72, 9.64), self-esteem (β = 1.3; 95% CI = 0.96, 1.57), negative attitude (β = 5.1; 95% CI = 1.86, 8.33), waiting treatment (β = -8.4; 95% CI = -15.54, -1.10), and low intention (β = 4.7; 95% CI = 1.52, 7.93) were predictors of the quality of life in physical domain. Repair outcome without urinary inconsistence (β = 5.9; 95% CI = 1.73, 9.99), self-esteem (β = 1.8; 95% CI = 1.47, 2.11), negative attitude (β = -6.4; 95% CI = -9.60, -3.25), fathers at primary school (β = 12.5; 95% CI = 0.08, 24.82), living only with parents (β = 4.9; 95% CI = 0.99, 8.90), time of care-seeking (β = -0.01, 95% CI = -0.02, -0.002), and duration lived with fistula (β = -5.4; 95% CI = -9.12, -1.68) were predictors of psychological domain. Dead birth (β = -5.2; 95% CI = -9.86, -0.51), self-esteem (β = 1.1; 95% CI = 0.72, 1.43), and living only with parents (β = 5.5; 95% CI = 0.30, 10.69), and living only with husband (β = 7.8; 95% CI = 2.01, 13.55) were predictors of social domain. Living in rural (β = -6; 95% CI = -9.22, -2.79), women at secondary school (β = 14.1; 95% CI = 3.67, 24.48), self-esteem (β = 1.3; 95% CI = 0.99, 1.55), negative attitude (β = -5.1; 95% CI = -7.97, -2.29) were predictors of quality of life in environmental domain. Repair outcome without urinary inconsistence (β = 8.3; 95% CI = 0.62, 16.02), self-esteem (β = 2.1; 95% CI = 1.34, 2.79), and living only with parents (β = 2.9; 95% CI = 1.06, 4.76) were significant predictors of the overall quality of life.

Conclusions

The quality of life of women with obstetric fistula was low. Repair outcomes, self-esteem, negative attitudes, rural residence, living with parents, and time of care-seeking were significant predictors of quality of life. Urgent measures should be taken to address these factors to improve the quality of life of women with fistula.

Quality of life and associated factors among women with obstetric fistula in Ethiopia

Background

Obstetric fistula is an abnormal opening between the vagina and bladder or rectum. Women affected by obstetric fistula are often abandoned by their husbands, stigmatized by the community, physically debilitated and blamed for their conditions. These factors lead the victims to low self esteem, depression and prolonged emotional trauma. The physical, emotional and social suffering associated with continuous leakage of urine has a profound impact on women quality of life. The aim of this study was to assess quality of life and associated factors among obstetric fistula patients in Ethiopia, and it will have a significant role for further intervention.

Objective

To assess quality of life and associated factors among obstetric fistula patients in Ethiopia, 2017.

Methods

Institution based cross-sectional study design was conducted at fistula centers in Ethiopia. Systematic sampling technique was used to recruit a total of 289 women with obstetric fistula. The World Health Organization Quality of Life—Brief (WHOQOL-BREF) Version was used to assess quality of life. We computed simple and multiple linear regression analysis to assess factors associated with quality of life and P-value < 0.05 was declared statistically significant. Adjusted unstandardized β coefficient of multiple linear regressions was used to describe associated factors of quality of life.

Result

Of 289 women studied, only 12.1% felt satisfied with their general state of health and quality of life. In the physical health domain, the mean quality of life score was 40.78 ± .78. In the psychological domain, the mean quality of life score was 39.96 ± .82. In the social and environmental domain, the mean quality of life score was 32.9 ± .95, 36.45 ± .8, respectively. Duration of incontinence (β =  − 3.8,95% CI(− 6.95, − .62), patients coming for surgical procedure (β =  − 4.4, 95% CI(− 7.64, − 1.2), poor social support(β =  − 6.14, 95%CI (− 8.8, − 3.4), co-morbid anxiety (β =  − 4, 95% CI (− 7,-1.1) and depression (β =  − 9.2, 95% CI (− 12, − 6.4) were negatively associated with physical domain of quality of life. Co-morbid anxiety (β =  − 11,95% CI (− 14.8, − 7.3), employment (β = 9.1,95% CI (.5, 17.6), number of children(β = 2.1,95%CI(.8, 3.4), and depression(β =  − 6.3,95%CI(− 9.7, − 2.9) were associated with a psychological domain. Duration of incontinence (β =  − 8.1, 95%CI(− 12.82, − 3.4), poor social support (β =  − 7.8(− 12, − 3.6), patients coming for surgical procedure (β =  − 12, 95%CI (− 17.4, − 6.4) and co-morbid anxiety (β =  − 9.2, 95% CI (− 13.8, 4.5) were negatively associated with social domain of quality of life. Number of children present (β = 2.4, 95%CI (.82, 3.6), and poor social support (β =  − 5.5, 95%CI (− 9.5, − 1.5) were significantly associated with an environmental domain of quality of life.

Conclusion and recommendation

Co-morbid depression and anxiety, poor social support, duration of urine incontinence, employment, number of children, and duration of hospital stay were factors significantly associated with domains of QOL. Treating co-morbid depression and anxiety, and social support are necessary to increase women’s quality of life. In addition, it is better to have a plane of income generation victims, and awareness creation about early treatment of the problem for community by the concerned body to improve women quality of life.

Reflections on Identity: Narratives of Obstetric Fistula Survivors in North Central Nigeria

Obstetric fistula is a condition that affects women and can lead to identity changes because of uncontrolled urinary and/or fecal incontinence symptom experiences. These symptoms along with different emerging identities lead to family and community displacement. Using narrative inquiry methodology that concentrates on the stories individuals tell about themselves; interviews were conducted for 15 fistula survivors to explore their perception of identities of living with obstetric fistula. Within a sociocultural context, these identities consist of the "leaking" identity, "masu yoyon fitsari" (leakers of urine) identity, and the "spoiled" identity, causing stigmatization and psychological trauma. The "masu yoyon fitsari" identity, however, built hope and resilience for a sustained search for a cure. Identity is a socially constructed phenomenon, and the findings reveal positive community involvement which reduces obstetric fistula stigmatization and improves women's identity. Sexual and reproductive health issues remain of grave concern within a contextualized societal identity of women's role.

Assessing quality of life in obstetric fistula patients: Validation of the urogenital distress inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) in Lingala and Kikongo in DR Congo

AIMS

The Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) are both well-known. In obstetric fistula (OF) repair outcome is usually assessed by the surgical team. The patient perspective is often neglected. Therefore we translated both questionnaires in Lingala and Kikongo, official languages in DR Congo. Secondly used the questionnaires in an OF population to assess the real life continence status and the impact of fistula repair surgery.

METHODS

UDI-6 and IIQ-7 were translated and underwent content validity checks using focus groups. The final versions were tested in a normal population and in an OF population (33 for Kikongo, 35 for Lingala) for internal consistency and test-retest reliability. The responsiveness was tested in an OF population and effect sizes were calculated.

RESULTS

Both questionnaires showed good internal consistency and reliability. The Cronbach's α for UDI-6 in both languages was 0.47 for the IIQ-7, 0.96 for Lingala and 0.94 for Kikongo in an OF population. The test-retest reliability was high in all cohorts. Both questionnaire scores improved significantly after fistula repair. The effect size for UDI-6 was -1.09 and -1.6 for IIQ-7.

CONCLUSION

Both IIQ-7 and UDI-6 questionnaires have been translated in Lingala and Kikongo, two languages of DR Congo. The questionnaires have been validated in an obstetrical fistula population, showing good content validity and test-retest reliability. The questionnaires show a highly significant effect size, demonstrating the dramatic positive effect of fistula surgery on urogenital symptoms and on the quality of live in an obstetric fistula population.

Marital disruption among women with genital fistula in Nigeria: who is at greatest risk?

INTRODUCTION AND HYPOTHESIS

Marital disruption is a commonly identified sequela of genital fistula in developing countries. This study is aimed at identifying factors that correlate with marital outcomes.

METHODS

All new patients presenting to Evangel VVF Centre in Jos, Nigeria, between August 2015 and August 2017, were retrospectively reviewed with regard to demographics, medical history, and fistula details to identify variables correlating with marital status, particularly whether currently married or presently divorced, separated, or divorced and remarried (cumulatively the "divorce group").

RESULTS

Among 581 new patients, 66% were married and 18% experienced marital disruption. Presence of living children in the home and having attended any level of formal education were found to be protective of marriage (p values <0.0001 and 0.0045 respectively). Patients in the divorce group were more likely to have delivered a baby before the age of 18, be of Muslim background, and have a longer time since fistula formation (p values all <0.0001), as were those married younger than 18 and those whose fistula followed a vaginal delivery (p values 0.0015 and 0.0017 respectively).

CONCLUSION

Several factors correlate with disruption of the marriage relationship. Patients at highest risk for marital disruption should be identified early and provided with interventions aimed at protecting their marriage and social support system.

Continence, quality of life and depression following surgical repair of obstetric vesicovaginal fistula: a cohort study

OBJECTIVE

We evaluated residual incontinence, depression, and quality of life among Malawian women who had undergone vesicovaginal fistula (VVF) repair 12 or more months previously.

DESIGN

Prospective cohort study.

SETTING

Fistula Care Centre in Lilongwe, Malawi.

POPULATION

Women who had undergone VVF repair in Lilongwe, Malawi at least 12 months prior to enrolment.

METHODS

Self-report of urinary leakage was used to evaluate for residual urinary incontinence; depression was evaluated with the Patient Health Questionnaire-9; quality of life was evaluated with the King's Health Questionnaire.

MAIN OUTCOME MEASURES

Prevalence and predictors of residual incontinence, quality of life scores, and prevalence of depression and suicidal ideation.

RESULTS

Fifty-six women (19.3%) reported residual urinary incontinence. In multivariable analyses, predictors of residual urinary incontinence included: pre-operative Goh type 3 [adjusted risk ratio (aRR) 2.82; 95% confidence interval (CI) 1.61-5.27) or Goh type 4 1.08-2.78), positive postoperative cough stress test (aRR = 2.42; 95% CI 1.24-4.71) and the positive 1-hour postoperative pad test (aRR = 2.20; 95% CI 1.08-4.48). Women with Goh types 3 and 4 VVF reported lower quality of life scores. Depressive symptoms were reported in 3.5% of women; all reported residual urinary incontinence.

CONCLUSIONS

While the majority of women reported improved outcomes in the years following surgical VVF repair, those with residual urinary incontinence had a poorer quality of life. Services are needed to identify and treat this at-risk group.

TWEETABLE ABSTRACT

Nearly one in five women reported residual urinary incontinence at follow up, 12 or months after vesicovaginal fistula repair.

Quality of life among women in Bangladesh following ileal conduit urinary diversion operations for irreparable vesicovaginal fistula and bladder exstrophy: observational study

OBJECTIVE

To determine the quality of life (QOL) of fistula patients in Bangladesh who have undergone ileal conduit (IC) urinary diversion operations, and to assess whether the risks and ethical challenges involved, outweigh the reality of leaving a woman with urinary incontinence for the rest of her life.

DESIGN

Observational study.

SETTING

LAMB Hospital, Bangladesh.

POPULATION

Seventeen women who had undergone IC between February 2012 and March 2016: 14 women previously had irreparable obstetric fistulas and three had bladder exstrophy.

METHODS

Demographic, obstetric, IC-related, stigma and discrimination information were collected by questionnaire. Univariate analysis was done using the two-sided t-test for comparison of differences before and after IC surgery.

MAIN OUTCOME METHODS

Change in stigma and discrimination scores. Health-related QOL assessed using the 36-item Short Form Health Survey.

RESULTS

Of the 17 women, 14 (82.3%) felt they were cured of their fistula disease. Three complained of occasional leakage due to insufficient seal of the bag, mainly at night, and all but one experienced no limits to their daily activities. Stigma and discrimination scores were significantly lower after having the IC surgery. The mean difference from when the woman had a fistula to when she had an IC for stigma score was 3.17 (1.12-4.16, P < 0.001), and for discrimination score was 3 (1.9-4.1, P < 0.001).

CONCLUSION

Overall, there has been improved QOL following IC among the women in this study and all would recommend IC to women in the same situation. They remain chronic patients with some physical symptoms, but are well re-integrated back into their communities.

TWEETABLE ABSTRACT

Improved QOL following ileal conduit in women with persistent fistula related disorder in Bangladesh.