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Pollaczek L, Rajagopal K, Chu J. Patient characteristics, surgery outcomes, presumed aetiology and other characteristics of fistula surgeries and related procedures supported by Fistula Foundation from 2019 to 2021: a multicentre, retrospective observational study. BMJ Open 2024; 14:e078426. [PMID: 38485171 PMCID: PMC10941128 DOI: 10.1136/bmjopen-2023-078426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Obstetric fistula is a devastating childbirth injury primarily caused by prolonged, obstructed labour. It leaves women incontinent, severely stigmatised and isolated. Fistula repair surgery can restore a woman's health and well-being. Fistula Foundation, a non-profit organisation, works in partnership with local hospitals and community organisations in Africa and Asia to address key barriers to treatment and to increase the number of women receiving surgical care. This paper presents data on fistula and fistula repair surgery across a large global network of hospitals supported by Fistula Foundation. The data were collected between 2019 and 2021. DESIGN Multicentre, retrospective, observational, descriptive study. SETTING AND PARTICIPANTS The study analysed deidentified data from 24 568 surgical repairs supported by Fistula Foundation to treat women with obstetric fistula at 110 hospitals in 27 countries. RESULTS The data highlight patient characteristics and key trends and outcomes from obstetric fistula repair surgeries and related procedures. Of those surgeries, 87% resulted in a successful outcome (fistula dry and closed) at the time of discharge, highlighting the effectiveness of fistula repair in restoring continence and improving quality of life. Over the period studied, the number of supported surgeries increased by 14%, but there remains an urgent need to strengthen local surgical capacity and improve access to treatment. Women suffered an average of 5.7 years before they received surgery and only 4% of women sought care independently. This underscores the importance of enhancing community awareness and strengthening referral networks. CONCLUSIONS This research provides essential insight from a vast, global network of hospitals providing highly effective fistula repair surgery. Further investment is needed to strengthen surgical capacity, increase awareness of fistula and remove financial barriers to treatment if stakeholders are to make significant progress towards the United Nations' ambitious vision of ending fistula by 2030.
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Affiliation(s)
| | | | - Jesse Chu
- Fistula Foundation, San Jose, California, USA
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El Ayadi AM, Alway J, Matityahu D, Kichwen C, Wilson S, Mabeya H. Impact of Beyond Fistula programming on economic, psychosocial and empowerment outcomes following female genital fistula repair: A retrospective study. Int J Gynaecol Obstet 2024; 164:1064-1073. [PMID: 37746937 DOI: 10.1002/ijgo.15133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To retrospectively assess changes in economic status, psychosocial status and empowerment among women who participated in Beyond Fistula reintegration programming following fistula repair. METHODS We conducted a retrospective study among 100 Beyond Fistula program participants capturing sociodemographic characteristics, obstetric and fistula history, program participation, and our primary outcomes: economic status, psychosocial status, and empowerment via quantitative survey at two time points: before program participation and currently. Data were collected from November 2020 to July 2021 from 2013 to 2019 program participants. We compared outcomes across these two time points using paired t tests or McNemar's tests. RESULTS The proportion of individuals owning property (28.0% vs. 38.0%, P = 0.006), having a current source of income (19.0% vs. 56.0%, P < 0.001), and saving or investing income (11.0% vs. 37.0%, P < 0.001) increased significantly from pre- to post-programming. We also identified statistically significant increases from pre- to post-programming in self-esteem (5.0 [IQR 4.0-5.0] vs. 5.0 [IQR 5.0-5.0], P < 0.001), reintegration (53.0 [IQR 43.0-69.0] vs. 65.0 [IQR 51.0-72.0], P < 0.001) and level of input into household economic decision making (2.0 [SD 1.0] vs. 2.3 [SD 1.0], P = 0.004). CONCLUSION Beyond Fistula programming likely improved economic status, psychosocial status, and empowerment of participants. Post-surgical interventions incorporating a holistic approach can advance recovery through supporting psychosocial and economic wellbeing and should be offered to women undergoing genital fistula repair.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jessica Alway
- School of Public Health, University of California, Berkeley, California, USA
| | - Debra Matityahu
- Beyond Fistula, Eldoret, Kenya
- The Permanente Medical Group, Redwood City, California, USA
| | | | | | - Hillary Mabeya
- Beyond Fistula, Eldoret, Kenya
- Moi University School of Medicine, Eldoret, Kenya
- Gynocare Women's and Fistula Hospital, Eldoret, Kenya
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Asiedua E, Maya E, Ganle JK, Eliason S, Ansah-Ofei AM, Senkyire EK, Adanu R. Health-seeking experiences of women with obstetric fistula: a qualitative study at two fistula centres in Ghana. BMJ Open 2023; 13:e064830. [PMID: 37591645 PMCID: PMC10441049 DOI: 10.1136/bmjopen-2022-064830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/10/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES The study explored the health-seeking experiences of women with obstetric fistula from the onset of the condition until surgical treatment was obtained. It also describes their interactions with health staff and traditional healers. DESIGN Exploratory, descriptive qualitative study. SETTING Two secondary-level health facilities in the northern and central regions of Ghana; data collection took place in 2018-2019. PARTICIPANTS A purposive sample of 37 women who had experienced fistula resulting from childbirth and were awaiting fistula repair at the two fistula centres in Ghana was obtained. DATA ANALYSIS Thematic analysis was used to analyse the data. RESULTS Health-seeking experiences and behaviours of women with obstetric fistula were identified. Six major themes were generated: attribution and perceptions of fistula; competing alternatives/multiple sources of care; limited awareness and access to care; financial barriers; psychosocial challenges, and abuse by healers. The results indicate that the health-seeking experiences of women with obstetric fistula were characterised by long delays in care-seeking. The major themes and subthemes are presented with quotes from participants. CONCLUSION The women experienced winding pathways of treatment-seeking due to lack of awareness and incorrect attribution. The major barriers to health-seeking included poverty, challenges with transportation and inadequate repair centres. Increased awareness of obstetric fistula and access to repair centres could shorten the suffering women go through while awaiting fistula treatment. Improved awareness of obstetric fistula and establishment of more fistula centres would be beneficial.
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Affiliation(s)
- Ernestina Asiedua
- School of Nursing & Midwifery, Department of Maternal and Child Health, University of Ghana, Legon, Ghana
| | - Ernest Maya
- School of Public Health, Department of Population, Family, and Reproductive Health, University of Ghana, Legon, Ghana
| | - John Kuumuori Ganle
- School of Public Health, Department of Population, Family, and Reproductive Health, University of Ghana, Legon, Ghana
| | - Sebastian Eliason
- School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Adelaide Maria Ansah-Ofei
- School of Nursing & Midwifery, Department of Research, Education and Administration, University of Ghana, Legon, Ghana
| | | | - Richard Adanu
- School of Public Health, Department of Population, Family, and Reproductive Health, University of Ghana, Legon, Ghana
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Nduka IR, Ali N, Kabasinguzi I, Abdy D. The psycho-social impact of obstetric fistula and available support for women residing in Nigeria: a systematic review. BMC Womens Health 2023; 23:87. [PMID: 36841757 PMCID: PMC9960620 DOI: 10.1186/s12905-023-02220-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/09/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Obstetric fistula continues to affect the social and mental wellbeing of women living in Nigeria giving rise to poor maternal health outcome. While the World Health Organisation (WHO) has recommended the introduction of psycho-social interventions in the management of obstetric fistula women, psycho-social support for women living with obstetric fistula in Nigeria, are limited. This systematic review aimed to synthesise the psycho-social impact of obstetric fistula on women living in Nigeria as well as the available psycho-social support for these affected women. METHODS Following a keyword strategy, Medline, CINAHL, Google scholar, ScienceDirect, Cochrane library, PsychINFO, AMED, British Nursing database, Pubmed central, TRIP database, UK Pubmed central, socINDEX, Annual reviews, ISI Web of Science, Academic search complete, Credo reference, Sage premier and Scopus databases were searched alongside hand searching of articles. The inclusion criteria were set as articles published between 2000 and 2020, on the psychosocial consequences of obstetric fistula in Nigeria. The Critical Appraisal Skills Program (CASP) tool was used to appraise the quality of the included studies. The data was extracted and then analysed using narrative synthesis. RESULTS 620 relevant citations were identified, and 8 studies were included. Women with obstetric fistula, living in Nigeria were found to be ostracised, abandoned by families and friends, stigmatised and discriminated against, which led to depression, loneliness, loss of self-esteem, self-worth and identity. Psycho-social interventions for women who experienced obstetric fistula are not widely available. CONCLUSION There is a need for the introduction of more rehabilitation and reintegration programs across the country. The psychosocial effect of obstetric fistula is significant and should be considered when developing interventions. Further, more research is needed to evaluate the sustainability of psychosocial interventions in Nigeria.
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Affiliation(s)
| | - Nasreen Ali
- grid.15034.330000 0000 9882 7057Institute of Health Research, University of Bedfordshire, Luton, LU1 3JU UK
| | - Isabella Kabasinguzi
- grid.15034.330000 0000 9882 7057Institute of Health Research, University of Bedfordshire, Luton, LU1 3JU UK
| | - David Abdy
- grid.15034.330000 0000 9882 7057Institute of Health Research, University of Bedfordshire, Luton, LU1 3JU UK
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El Ayadi AM, Nalubwama H, Barageine JK, Miller S, Obore S, Kakaire O, Korn A, Lester F, Diamond-Smith NG, Mwanje H, Byamugisha J. Feasibility and acceptability of mobile phone data collection for longitudinal follow-up among patients treated for obstetric fistula in Uganda. Health Care Women Int 2022; 43:1340-1354. [PMID: 33030977 PMCID: PMC9318213 DOI: 10.1080/07399332.2020.1825439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
Rapid dissemination of mobile technology provides substantial opportunity for overcoming challenges reaching rural and marginalized populations. We assessed feasibility and acceptability of longitudinal mobile data capture among women undergoing fistula surgery in Uganda (n = 60) in 2014-2015. Participants were followed for 12 months following surgery, with data captured quarterly, followed by interviews at 12 months. Participant retention was high (97%). Most respondents reported no difficulty with mobile data capture (range 93%-100%), and preferred mobile interview (88%-100%). Mobile data capture saved 1000 person-hours of transit and organizational time. Phone-based mobile data collection provided social support. Our results support this method for longitudinal studies among geographically and socially marginalized populations.
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Affiliation(s)
- Alison M. El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus K. Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Maternal and Child Health, Uganda Christian University, Mukono, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Susan Obore
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Felicia Lester
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Nadia G. Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Haruna Mwanje
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
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Hurissa BF, Koricha ZB, Dadi LS. Quality of life and its predictive factors among women with obstetric fistula in Ethiopia: A cross-sectional study. Front Public Health 2022; 10:987659. [PMID: 36388323 PMCID: PMC9650212 DOI: 10.3389/fpubh.2022.987659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/14/2022] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
- Bekana Fekecha Hurissa
- School of Midwifery, Institute of Health, Jimma University, Jimma, Ethiopia,*Correspondence: Bekana Fekecha Hurissa ;
| | - Zewdie Birhanu Koricha
- Department of Health, Behavior, and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Lelisa Sena Dadi
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Hurissa BF, Koricha ZB, Dadi LS. The Predictors of Intent to Prevent Obstetric Fistula Recurrence Among Women with Fistula in Ethiopia: A Facility-Based Cross-Sectional Study. Int J Womens Health 2022; 14:1323-1335. [PMID: 36134389 PMCID: PMC9484077 DOI: 10.2147/ijwh.s378162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Obstetric fistula recurrence predisposes to a decreasing success rate of fistula repair and accounts for the continued incidence of obstetric fistulas in low-income countries. Evidence has revealed that there are women’s intent gaps in the prevention of obstetric fistula recurrence. Assessments of predictors of intent to prevent obstetric fistula recurrence among women with fistula are scarce. Objective This study assessed the intent to prevent obstetric fistula recurrence and its predictive factors among women with obstetric fistula in Ethiopia. Methods Facility-based cross-sectional study was conducted from April 01, 2019, to August 01, 2019, with consecutively selected 478 women with fistulas in five fistula treatment centers in Addis Ababa and Oromia regions. Data were collected using an interviewer-administered structured questionnaire and analyzed using SPSS 23 software. Simple and multiple linear regression models were fitted for data analysis. Results Mean score of intent to prevent obstetric fistula recurrence among women with obstetric fistula was 27.72 ± 5.06. Living in a rural setting (β =−2.27; 95% CI: −3.62, −0.93), being married (β =1.71, 95% CI: 0.56, 2.85), having one previous repair (β =2.14, 95% CI: 0.19, 4.08), high self-esteem (β =1.42, 95% CI: 0.09, 2.74), psychological health (β =0.05, 95% CI: 0.26, 3.79), living with fistula ≥5 years (β =1.82, 95% CI: 0.44, 3.21), high knowledge of risk factors (β =3.12, 95% CI: 1.99, 4.25), and a positive attitude (β =2.33, 95% CI: 1.12, 3.54) were significant predictors of the intent to prevent obstetric fistula recurrence. Conclusion Intent to prevent obstetric fistula recurrence among women with obstetric fistula was low. This indicates an urgent need to create awareness among women with an obstetric fistula on the risk factors of obstetric fistula recurrence, attitudinal changes towards prevention of obstetric fistula recurrence, and the availability of prevention measures.
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Affiliation(s)
| | - Zewdie Birhanu Koricha
- Department of Health, Behavior, and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Lelisa Sena Dadi
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Pollaczek L, El Ayadi AM, Mohamed HC. Building a country-wide Fistula Treatment Network in Kenya: results from the first six years (2014-2020). BMC Health Serv Res 2022; 22:280. [PMID: 35232440 PMCID: PMC8889651 DOI: 10.1186/s12913-021-07351-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
It is estimated that one million women worldwide live with untreated fistula, a devastating injury primarily caused by prolonged obstructed labor when women do not have access to timely emergency obstetric care. Women with fistula are incontinent of urine and/or feces and often suffer severe social and psychological consequences, such as profound stigma and depression. Obstetric fistula affects economically vulnerable women and garners little attention on the global health stage. Exact figures on fistula incidence and prevalence are not known. In Kenya, results from a 2014 population-based survey suggest that 1% of reproductive-aged women have experienced fistula-like symptoms. In collaboration with key stakeholders, Fistula Foundation launched the Fistula Treatment Network (initially known as Action on Fistula) in 2014 to increase access to timely, quality fistula treatment and comprehensive post-operative care for women with fistula in Kenya. The integrated model built linkages between the community and the health system to support women through all parts of their treatment journey and to build capacity of healthcare providers and community leaders who care for these women. Fistula Foundation and its donors provided the program’s funding. Seed funding, representing about 30% of the program budget, was provided by Astellas Pharma EMEA. Over the six-year period from 2014 to 2020, the network supported 6,223 surgeries at seven hospitals, established a fistula training center, trained eleven surgeons and 424 Community Health Volunteers, conducted extensive community outreach, and contributed to the National Strategic Framework to End Female Genital Fistula. At 12 months post fistula repair, 96% of women in a community setting reported that they were not experiencing any incontinence and the proportion of women reporting normal functioning increased from 18% at baseline to 85% at twelve-months. The Fistula Treatment Network facilitated collaboration across hospital and community actors to enhance long-term outcomes for women living with fistula. This model improved awareness and reduced stigma, increased access to surgery, strengthened the fistula workforce, and facilitated post-operative follow-up and reintegration support for women. This integrated approach is an effective and replicable model for building capacity to deliver comprehensive fistula care services in other countries where the burden of fistula is high.
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Affiliation(s)
| | - Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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Rehabilitative care practices in the management of childbirth-related pelvic fistula: A systematic review. Int Urogynecol J 2021; 32:2311-2324. [PMID: 34089341 DOI: 10.1007/s00192-021-04845-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Childbirth-related pelvic fistula (CRF) often requires surgery, yet even with successful repair, mental health conditions, musculoskeletal impairments, urinary and fecal incontinence and sexual dysfunction persist for many women. Postoperative rehabilitation, (i.e., physiotherapy, mental health counseling) may address these concerns and has been reported for this population. This review aims to summarize the literature and level of evidence of rehabilitative care practices in fistula care to inform clinical practice, research and policy recommendations. METHODS A systematic literature review was conducted using Africa-Wide Information, CINAHL, Cochrane, Embase, Global Health, PAIS Index, PubMed and SCOPUS searching keywords and MeSH terms to identify women with CRF admitted for surgery. Two researchers progressively screened titles, abstracts and full-text articles. Eligible articles were classified primary if intervention details and outcomes were reported or secondary if rehabilitation was described, but no specific outcomes reported. Relevant study details, strengths and limitations, and key findings were extracted. RESULTS Eighteen articles were included: eight primary, ten secondary. Primary articles reported on urethral plugs for postoperative urinary incontinence (UI) (2/8), menstrual cup to manage UI (1/8), physiotherapy and health education (3/8) and mental health counseling (2/8). Secondary articles describe rehabilitation components in the context of program descriptions, qualitative analyses or reviews. All evidence was low or very low quality. CONCLUSIONS Research on rehabilitative care is very limited and highlights inconsistencies in practice. This review provides support for the feasibility of rehabilitation and establishes the need for future interventional studies that involve a comparator and reliable outcome measures.
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Measuring barriers to fistula care: investigating composite measures for targeted fistula programming in Nigeria and Uganda. BMC WOMENS HEALTH 2021; 21:142. [PMID: 33827536 PMCID: PMC8028827 DOI: 10.1186/s12905-021-01288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Accessing surgical repair poses challenges to women living with female genital fistula who experience intersectional vulnerabilities including poverty, gender, stigma and geography. Barriers to fistula care have been described qualitatively in several low- and middle-income countries, but limited effort has been made to quantify these factors. This study aimed to develop and validate composite measures to assess barriers to accessing fistula repair in Nigeria and Uganda. METHODS This quantitative study built on qualitative findings to content validate composite measures and investigates post-repair client surveys conducted at tertiary hospitals in Northern and Southern Nigeria and Central Uganda asking women about the degree to which a range of barriers affected their access. An iterative scale development approach included exploratory and confirmatory factor analyses of two samples (n = 315 and n = 142, respectively) using STATA 13 software. Reliability, goodness-of-fit, and convergent and predictive validity were assessed. RESULTS A preliminary 43-item list demonstrated face and content validity, triangulated with qualitative data collected prior to and concurrently with survey data. The iterative item reduction approach resulted in the validation of a set of composite measures, including two indices and three sub-scales. These include a Financial/Transport Inaccessibility Index (6 items) and a multidimensional Barriers to Fistula Care Index of 17 items comprised of three latent sub-scales: Limited awareness (4 items), Social abandonment (6 items), and Internalized stigma (7 items). Factor analyses resulted in favorable psychometric properties and good reliability across measures (ordinal thetas: 0.70-0.91). Higher levels of barriers to fistula care are associated with a woman living with fistula for longer periods of time, with age and geographic settings as potential confounders. CONCLUSIONS This set of composite measures that quantitatively captures barriers to fistula care can be used separately or together in research and programming in low- and middle-income countries.
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Degge HM, Laurenson M, Dumbili EW, Hayter M. Insights from birthing experiences of fistula survivors in North-central Nigeria: Interplay of structural violence. Nurs Inq 2020; 27:e12377. [PMID: 32862483 DOI: 10.1111/nin.12377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/08/2020] [Accepted: 07/26/2020] [Indexed: 11/28/2022]
Abstract
Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. Studies indicate that delays in accessing maternal care and home birth contribute to the development of fistula. Survivors are usually women of low socioeconomic status residing in rural locations. This study explores the birthing experiences of 15 fistula survivors through a narrative inquiry approach at a repair centre in North-central Nigeria. Using structural violence as a lens, it describes the role of social, political and health systems in the inequitable access to care for women. For women opting for home births, preference for home delivery was mainly due to lack of finances, poor health systems and cultural practices. Rural location inhibited access as women seeking facility delivery faced transfer delays to referral centres when complications developed. Inequitable maternal health services in rural locations in Nigeria are inherently linked to access to health care, and these contribute to the increased incidence of fistulae. Structural intervention is a health policy priority to address poor health systems and achieve universal health coverage to address maternal health issues in Nigeria.
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Affiliation(s)
| | - Mary Laurenson
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Emeka W Dumbili
- Department of Sociology and Anthropology, Faculty of Social Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Mark Hayter
- Faculty of Health Sciences, University of Hull, Hull, UK
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den Hollander GC, Janszen EWM. Obstetric fistulas in Uganda: scoping review using a determinant of health approach to provide a framework for health policy improvement. BMC Pregnancy Childbirth 2020; 20:257. [PMID: 32349703 PMCID: PMC7189698 DOI: 10.1186/s12884-020-02951-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/16/2020] [Indexed: 01/21/2023] Open
Abstract
Background The uneven global and national distribution of obstetric fistulas suggests a complex network of determinants contributing to fistula development. This study aims to create an understanding of the determinants of obstetric fistula in Uganda and to give a framework for health policy improvement. Methods A scoping review of existing literature was performed, searching the PubMed/MEDLINE database, Ugandan Demographic and Health Surveys, and official sources of Ugandan statistics. Data was analysed using the model for the determinants of health by Dahlgren and Whitehead. Results Obstetric fistulas are associated with different personal lifestyle factors, certain social and community networks, as well as poor working and living conditions. Malnutrition, early childbearing, limited female empowerment, lack of awareness of childbearing risks, low socioeconomic status, and long distances to emergency obstetric care play a part. Certain regions of Uganda are in particular associated with obstetric fistula, where an accumulation of determinants is notable. Conclusion Analysis using the model of Dahlgren and Whitehead shows that obstetric fistulas are associated with determinants at different levels of society. Poverty and low education link these in a web that is disproportionately hard to escape from for the poorest women. This inequity asks for co-operation between ministries to dismantle the environment for obstetric fistula.
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Affiliation(s)
- Geerte C den Hollander
- Maternity and Surgical Departments, Saint Francis Hospital, Mutolere, Kisoro Municipality Council, Kisoro, Uganda.
| | - Erica W M Janszen
- Gynaecology and Obstetrics Department, Kampala Hospital, 6C Makindu Close, Kololo, Kampala, Uganda.,Gynaecology and Obstetrics Department, OLVG Hospital, location Oost, Oosterpark 9, Amsterdam, the Netherlands
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13
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Degge HM, Laurenson M, Dumbili EW, Hayter M. Reflections on Identity: Narratives of Obstetric Fistula Survivors in North Central Nigeria. QUALITATIVE HEALTH RESEARCH 2020; 30:366-379. [PMID: 31578929 DOI: 10.1177/1049732319877855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Tripathi V, Arnoff E, Sripad P. Removing barriers to fistula care: Applying appreciative inquiry to improve access to screening and treatment in Nigeria and Uganda. Health Care Women Int 2019; 41:584-599. [PMID: 31335303 DOI: 10.1080/07399332.2019.1638924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A research-to-action collaboration sought to understand and respond to barriers to female genital fistula treatment in Nigeria and Uganda. This was guided by appreciative inquiry, a participatory approach for transformative programing with four phases: (1) inquire, (2) imagine, (3) innovate, and (4) implement. Through this process, partners designed and refined a treatment barrier reduction intervention using multiple communication channels to disseminate a consistent fistula screening algorithm and provide transportation vouchers to those screening positive. Partnership between an implementation organization, a research institution, and local community partners enabled data-driven design and patient-centered implementation to address specific barriers experienced by women.
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Affiliation(s)
| | - Elly Arnoff
- Fistula Care Plus Project, EngenderHealth, Washington, DC, USA
| | - Pooja Sripad
- Maternal Newborn Health, Population Council, Washington, DC, USA
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15
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Khisa AM, Nyamongo IK, Omoni GM, Spitzer RF. A grounded theory of regaining normalcy and reintegration of women with obstetric fistula in Kenya. Reprod Health 2019; 16:29. [PMID: 30849992 PMCID: PMC6408802 DOI: 10.1186/s12978-019-0692-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 02/21/2019] [Indexed: 11/24/2022] Open
Abstract
Background Obstetric fistula is a reproductive health problem causing immense suffering to 1% of women in Kenya that is formed as sequelae of prolonged obstructed labour. It is a chronic illness that disrupts women lives, causing stigma and isolation. Fistula illness often introduces a crisis in women’s life begetting feelings of shame and serious disruption to their social, psychological, physical and economic lives, in addition to dealing with moral and hygiene challenges. Currently, women undergo free of charge surgery at vesicovaginal fistula (VVF) camps held in national referral hospitals and dedicated fistula centres generating a significant pool of women who have undergone surgery and are ready to regain normal lives. Objective The purpose of this study was to explore experiences of women immersing back into communities and their return to normalcy after surgery in three VVF repair centres in Kenya. We set out to answer the question: what strategies improve obstetric fistula patients’ reintegration process? Methods We used grounded theory methodology to capture the reintegration and regaining normalcy experiences of women after surgery. Narrative interviews were held with 60 women during community follow-up visits in their homes after 6–19 months postoperatively. Grounded theory processes of theoretical sampling, repeated measurement; constant comparative coding in three stage open, axial and selective coding; memoing, reflexivity and positionality were applied. Emergent themes helped generate a grounded theory of reintegration and regaining normalcy for fistula patients. Results To regain normal healthy lives, women respond to fistula illness by seeking surgery.. After surgery, four possible outcomes of the reintegration process present; reintegration fully or partially back into their previous communities, not reintegrated or newly integrating away from previous social and family settings. The reintegration statuses point to the diversity outcomes of care for fistula patients and the necessity of tailoring treatment programs to cater for individual patient needs. Conclusion The emerging substantive theory on the process of reintegration and regaining normalcy for fistula patients is presented. The study findings have implications for fistula care, training and policy regarding women’s health, suggesting a model of care that encompasses physical, social, economic and psychological aspects of care after surgery and discharge.
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Affiliation(s)
- Anne M Khisa
- University of Nairobi, School of Nursing Sciences, P.O. Box 30197-00100, Nairobi, Kenya. .,African Population and Health Research Centre, P.O. Box 10787-00100, Nairobi, Kenya.
| | - Isaac K Nyamongo
- Division of Cooperative Development, Research and Innovation, The Cooperative University of Kenya, P.O. Box 24814-00502, Nairobi, Kenya.,University of Nairobi, Institute of Anthropology, Gender and African Studies, P.O. Box 30197-00100, Nairobi, Kenya
| | - Grace M Omoni
- University of Nairobi, School of Nursing Sciences, P.O. Box 30197-00100, Nairobi, Kenya
| | - Rachel F Spitzer
- University of Toronto, Dalla Lana School of Public Health, 155 College St. ON M57 3M7, Toronto, Canada
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Belayihun B, Mavhandu-Mudzusi AH. Effects of surgical repair of obstetric fistula on severity of depression and anxiety in Ethiopia. BMC Psychiatry 2019; 19:58. [PMID: 30732591 PMCID: PMC6367812 DOI: 10.1186/s12888-019-2045-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/30/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The surgical repair of fistula can address the physical symptoms, but may not end the psychological challenges that women with fistula face. There are a few studies that focus on women with this condition in Ethiopia. Hence, the aim of this study was to determine the effects of surgical repair of obstetric fistula on the severity of depression and anxiety in women with obstetric fistula in Ethiopia. METHOD The study employed a longitudinal study design to investigate the changes in 219 women with obstetric fistula admitted to six fistula management hospitals in Ethiopia. The data were collected on admission of the patients for obstetric fistula surgical repair and at the end of six-month post repair. A structured questionnaire was used to obtain socio-demographic information and medical history of the respondents. Depression and anxiety symptoms were measured using the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) scales. The data was entered using Epi-Data software and then exported to SPSS for further analysis. The Mann-Whitney-U test, the Kruskal-Wallis test and Paired t-test were performed to measure the change in psychological symptoms after surgical repair. RESULT Though 219 respondents were interviewed pre-obstetric fistula surgical repair, only 200 completed their follow up. On admission, the prevalence of depression and anxiety symptoms were 91 and 79% respectively. After surgical repair, the prevalence rate was 27 and 26%. The differences in the prevalence of screen-positive women were statistically significant (P < 0.001). CONCLUSION The study concluded that the severity of depression and anxiety symptoms decrease post-obstetric fistula surgical repair. However, a woman with continued leaking after surgery seems to have higher psychological distress than those who are fully cured. Clinicians should manage women with obstetric fistula through targeted and integrated mental health interventions to address their mental health needs.
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Affiliation(s)
- Bekele Belayihun
- Department of Health Studies, University of South Africa, Addis Ababa, Ethiopia.
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El Ayadi AM, Barageine J, Korn A, Kakaire O, Turan J, Obore S, Byamugisha J, Lester F, Nalubwama H, Mwanje H, Tripathi V, Miller S. Trajectories of women's physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study. Trop Med Int Health 2018; 24:53-64. [PMID: 30372572 PMCID: PMC6324987 DOI: 10.1111/tmi.13178] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery. METHODS We recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. RESULTS Across post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4). CONCLUSIONS Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Justus Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Janet Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Obore
- Urogynaecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felicia Lester
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Mwanje
- Urogynaecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | | | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
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Amodu OC, Salami BO, Richter MS. Obstetric fistula policy in Nigeria: a critical discourse analysis. BMC Pregnancy Childbirth 2018; 18:269. [PMID: 29945556 PMCID: PMC6020337 DOI: 10.1186/s12884-018-1907-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2012, Nigeria's Federal Ministry of Health published its National Strategic Framework for the Elimination of Obstetric Fistula (NSFEOF), 2011-2015. The framework has since lapsed and there is no tangible evidence that the goal of eliminating obstetric fistula was met. To further inform future policy directions on obstetric fistula in Nigeria, this paper explores how the NSFEOF conceptualized obstetric fistula and its related issues, including child marriage and early childbearing. METHODS A critical discourse analysis of the policy was performed. We examined four policies in addition to the strategic framework: the Nigerian constitution; the Marriage Act; the Matrimonial Causes Act; and the National Reproductive Health Policy. We used the three phases of critical discourse analysis: textual analysis, analysis of discourse practice, and analysis of discursive events as instances of sociocultural practice. RESULTS The analysis demonstrates that, despite its title, the policy document focuses on reduction rather than elimination of obstetric fistula. The overall orientation of the policy is downstream, with minimal focus on prevention. The policy language suggests victim blaming. Furthermore, the extent to which subnational stakeholders in government and civil society were engaged in decision-making process for developing this policy is ambiguous. Although the policy is ostensibly based on principles of social justice and equity, several rhetorical positions suggest that the Nigerian constitutional environment and justice systems make no real provisions to protect the reproductive rights of girls in accordance with the United Nations' "2030 Agenda for Sustainable Development." CONCLUSION This analysis establishes that the Nigerian constitution, justice environment and the obstetric fistula policy itself do not demonstrate clear commitment to eradicating obstetric fistula. Specifically, a clear commitment to eradicating obstetric fistula would see the constitution and Marriage Act of Nigeria specify an age of consent that is consistent with the agenda to prevent obstetric fistula. Additionally, a policy to end obstetric fistulas in Nigeria must purposefully address the factors creating barrier to women's access to quality maternal healthcare services. Future policies and programs to eliminate obstetric fistulas should include perspectives of nurses, midwives, researchers and, women's interest groups.
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Affiliation(s)
- Oluwakemi C. Amodu
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue NW, Edmonton, AB T6G 1C9 Canada
| | - Bukola O. Salami
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue NW, Edmonton, AB T6G 1C9 Canada
| | - Magdalena S. Richter
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue NW, Edmonton, AB T6G 1C9 Canada
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Mallick L, Tripathi V. The association between female genital fistula symptoms and gender-based violence: A multicountry secondary analysis of household survey data. Trop Med Int Health 2017; 23:106-119. [PMID: 29140584 DOI: 10.1111/tmi.13008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Demographic and Health Surveys (DHS), which include standardised questions on female genital fistula symptoms, provide a unique opportunity to evaluate the epidemiology of fistula. This study sought to examine associations between self-reported fistula symptoms and experience of gender-based violence (GBV) among women interviewed in DHS surveys. METHODS This study used data from thirteen DHS surveys with standardised fistula and domestic violence modules. Data from the most recent survey in each country were pooled, weighting each survey equally. Multivariable logistic regressions controlled for maternal and demographic factors. RESULTS Prevalence of fistula symptoms in this sample of 95 625 women ranges from 0.3% to 1.8% by country. The majority of women reporting fistula symptoms (56%) have ever experienced physical violence, and more than one-quarter have ever experienced sexual violence (27%), compared with 38% and 13% among women with no symptoms, respectively. Similarly, 16% of women with fistula symptoms report recently experiencing sexual violence-twice the percentage among women not reporting symptoms (8%). Women whose first experience of sexual violence was from a non-partner have almost four times the odds of reporting fistula symptoms compared with women who never experienced sexual violence. These associations indicate a need to investigate temporal and causal relationships between violence and fistula. CONCLUSIONS The increased risk of physical and sexual violence among women with fistula symptoms suggests that fistula programmes should incorporate GBV into provider training and services.
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Delamou A, Delvaux T, El Ayadi AM, Tripathi V, Camara BS, Beavogui AH, Romanzi L, Cole B, Bouedouno P, Diallo M, Barry TH, Camara M, Diallo K, Leveque A, Zhang WH, De Brouwere V. Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea: a longitudinal study. LANCET GLOBAL HEALTH 2017; 5:e1152-e1160. [PMID: 28941996 PMCID: PMC6530985 DOI: 10.1016/s2214-109x(17)30366-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/19/2017] [Accepted: 08/15/2017] [Indexed: 11/19/2022]
Abstract
Background Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. Methods We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. Findings 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28·0 months (IQR 14·6–36·6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56·5–89·3) and an incidence proportion of 18·4% (14·8–22·8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23·1 per 1000 person-years (14·0–36·2), and corresponding to 10·3% (5·2–19·6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106·0 per 1000 person-years, corresponding to 28·4% (22·8–35·0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. Interpretation Recurrence of female genital fistula and adverse pregnancy-related maternal and child health outcomes were frequent in women after fistula repair in Guinea. Interventions are needed to safeguard the health of women after fistula repair. Funding Belgian Development Cooperation (DGD), Institute of Tropical Medicine of Antwerp (ITM), and Maferinyah Training and Research Center in Rural Health (Guinea).
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Affiliation(s)
- Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea; Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Brussels, Belgium; Maternal & Reproductive Health Unit, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Therese Delvaux
- Maternal & Reproductive Health Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alison M El Ayadi
- Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | | | - Bienvenu S Camara
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea; Centre Medico-Social Jean Paul II, Conakry, Guinea
| | - Abdoul H Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | | | - Patrice Bouedouno
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | | | | | | | - Alain Leveque
- Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Wei-Hong Zhang
- Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Vincent De Brouwere
- Maternal & Reproductive Health Unit, Institute of Tropical Medicine, Antwerp, Belgium
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El Ayadi A, Nalubwama H, Barageine J, Neilands TB, Obore S, Byamugisha J, Kakaire O, Mwanje H, Korn A, Lester F, Miller S. Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women. Reprod Health 2017; 14:109. [PMID: 28865473 PMCID: PMC5581461 DOI: 10.1186/s12978-017-0372-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obstetric fistula is a debilitating and traumatic birth injury affecting 2-3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. METHODS We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov's ρ and Pearson's correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs. RESULTS Themes central to women's experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled 'Mobility and social engagement', 'Meeting family needs', 'Comfort with relationships', and 'General life satisfaction', and goodness of fit statistics supported a higher-order latent variable of 'Reintegration.' Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions. CONCLUSION As more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.
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Affiliation(s)
- Alison El Ayadi
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus Barageine
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, USA
| | - Susan Obore
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Mwanje
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Abner Korn
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Felicia Lester
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Suellen Miller
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
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22
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Singh S, Thakur T, Chandhiok N, Singh MK, Dhillon BS. Perceptions and experiences of women seeking treatment for obstetric fistula. Birth 2017; 44:238-245. [PMID: 28464510 DOI: 10.1111/birt.12291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To understand patients' perspectives on the causative factors and preventive measures of obstetric fistula; and the effect of fistula on the victims' psycho-social, sexual, and economic well being. METHODS A questionnaire-based interview of 215 women with obstetric fistula admitted for treatment in 17 hospitals in India was carried out during 2010-2011. Responses of participants from poor, medium, and better performing states were categorized into pre-coded themes and compared. RESULTS The majority of the women were from rural areas (75.3%), multiparous (68.8%), and with less than high school education (82.2%). The majority (70.7%) of the women reported attempt at home delivery by untrained persons. Poor awareness of where and when to seek care when faced with a difficult delivery, and poor quality of care in facilities were perceived as important causative factors. Delivery by trained providers and early referral of women with problems during labor were identified as important preventive factors. Spouses and families were supportive of treatment in spite of economic hardships, but most (79.5%) patients felt socially isolated after developing fistula. CONCLUSION Poor awareness regarding delivery care among the women indicates a need for increasing birth preparedness in the community. Patients' perceptions of poor quality of care in facilities need to be addressed urgently. Psychological evaluation and counseling should be offered to fistula patients, to help them cope with adverse psycho-social and economic circumstances. The results of this study may provide insights for prevention and management of fistula, and may help to improve patient care and services.
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Affiliation(s)
- Shalini Singh
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, New Delhi, India
| | - Tushita Thakur
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, New Delhi, India
| | - Nomita Chandhiok
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, New Delhi, India
| | - Manish Kumar Singh
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, New Delhi, India
| | - Balwan Singh Dhillon
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, New Delhi, India
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Angell JN, Busingye P, Ganyaglo GYK, Moyer CA. Root causes and social consequences of birth injuries in Western Uganda. Int J Gynaecol Obstet 2017; 139:100-101. [PMID: 28688109 DOI: 10.1002/ijgo.12257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/16/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022]
Affiliation(s)
| | - Priscilla Busingye
- Department of Obstetrics and Gynecology, Holy Family Virika Hospital, Fort Portal, Uganda
| | - Gabriel Y-K Ganyaglo
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Cheryl A Moyer
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Machiyama K, Hirose A, Cresswell JA, Barreix M, Chou D, Kostanjsek N, Say L, Filippi V. Consequences of maternal morbidity on health-related functioning: a systematic scoping review. BMJ Open 2017; 7:e013903. [PMID: 28667198 PMCID: PMC5719332 DOI: 10.1136/bmjopen-2016-013903] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To assess the scope of the published literature on the consequences of maternal morbidity on health-related functioning at the global level and identify key substantive findings as well as research and methodological gaps. METHODS We searched for articles published between 2005 and 2014 using Medline, Embase, Popline, CINAHL Plus and three regional bibliographic databases in January 2015. DESIGN Systematic scoping review PRIMARY OUTCOME: Health-related functioning RESULTS: After screening 17 706 studies, 136 articles were identified for inclusion. While a substantial number of papers have documented mostly negative effects of morbidity on health-related functioning and well-being, the body of evidence is not spread evenly across conditions, domains or geographical regions. Over 60% of the studies focus on indirect conditions such as depression, diabetes and incontinence. Health-related functioning is often assessed by instruments designed for the general population including the 36-item Short Form or disease-specific tools. The functioning domains most frequently documented are physical and mental; studies that examined physical, mental, social, economic and specifically focused on marital, maternal and sexual functioning are rare. Only 16 studies were conducted in Africa. CONCLUSIONS Many assessments have not been comprehensive and have paid little attention to important functioning domains for pregnant and postpartum women. The development of a comprehensive instrument specific to maternal health would greatly advance our understanding of burden of ill health associated with maternal morbidity and help set priorities. The lack of attention to consequences on functioning associated with the main direct obstetric complications is of particular concern. REVIEW REGISTRATION CRD42015017774.
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Affiliation(s)
- Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Atsumi Hirose
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jenny A Cresswell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Barreix
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Nenad Kostanjsek
- Department of Health Statistics and Informatics, World Health Organization, Classification, Terminology and Standards, Geneva, Switzerland
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Véronique Filippi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Mafo Degge H, Hayter M, Laurenson M. An integrative review on women living with obstetric fistula and after treatment experiences. J Clin Nurs 2017; 26:1445-1457. [PMID: 27680693 DOI: 10.1111/jocn.13590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To review literature on the experiences of women with obstetric fistula, their lived experiences after treatment; and to provide evidence for future research. BACKGROUND Obstetric fistula is an injury most commonly resulting from a prolonged labour. Long eradicated in developed countries, obstetric fistula remains a public health issue in sub-Saharan Africa and Asia. This is a highly stigmatised health condition, and an understanding of the women's experience is required to inform holistic approaches for care and prevention. DESIGN A search of literature was conducted on databases of EBSCO host (Academic Search Premier, MEDLINE, PsychINFO, CINAHL), Web of Science; and websites of international organizations such as Women's Dignity Project and EngenderHealth. Keywords, Inclusion and exclusion criteria were defined and 25 articles published between 2004 to January 2015 were identified. METHODS An integrative review of 25 articles was carried out. RESULTS Three broad themes were identified: Challenges of living with fistula; treatment and care experiences; and reintegration experiences of women after fistula repair. CONCLUSIONS Living with a fistula presents multidimensional consequences affecting women, families and communities. Accessing treatment is difficult and there are no standardised treatment packages. Surgical repairs were variable in their success rate. Some authors claim women resume normal lives irrespective of their continence status, whilst others claim they face discrimination despite being continent thereby hindering reintegration. Quality of life is diminished for those remaining incontinent. Post repair psychosocial support services are beneficial for reintegration, but research on programme benefits is limited. Therefore further research is required to support its benefits; and for policy development to meet care provision for women with fistula. RELEVANCE TO CLINICAL PRACTICE The review provides insights into avenues of improving care provision and delivery by health professionals and policy makers. It also exposes areas that need further research for quality care provision.
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Affiliation(s)
| | - Mark Hayter
- Sexual and Reproductive Health, Faculty of Health and Social Care, University of Hull, Hull, UK
| | - Mary Laurenson
- Faculty of Health and Social Care, University of Hull, Hull, UK
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26
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Delamou A, Delvaux T, Beavogui AH, Toure A, Kolié D, Sidibé S, Camara M, Diallo K, Barry TH, Diallo M, Leveque A, Zhang WH, De Brouwere V. Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice. Reprod Health 2016; 13:135. [PMID: 27821123 PMCID: PMC5100224 DOI: 10.1186/s12978-016-0248-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/19/2016] [Indexed: 12/04/2022] Open
Abstract
Background The prevention and treatment of obstetric fistula still remains a concern and a challenge in low income countries. The objective of this study was to estimate the overall proportions of failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identify its associated factors. Methods This was a retrospective cohort study using data extracted from medical records of fistula repairs between 1 January 2012 and 30 September 2013. The outcome was the failure of fistula closure and incontinence at hospital discharge evaluated by a dye test. A sub-sample of women with vesicovaginal fistula was used to identify the factors associated with these outcomes. Results Overall, 109 women out of 754 (14.5 %; 95 % CI:11.9–17.0) unsuccessful repaired fistula at discharge and 132 (17.5 %; 95 % CI:14.8–20.2) were not continent. Failure of fistula closure was associated with vaginal delivery (AOR: 1.9; 95 % CI: 1.0–3.6), partially (AOR: 2.0; 95 % CI: 1.1–5.6) or totally damaged urethra (AOR: 5.9; 95 % CI: 2.9–12.3) and surgical repair at Jean Paul II Hospital (AOR: 2.5; 95 % CI: 1.2–4.9). Women who had a partially damaged urethra (AOR: 2.5; 95 % CI: 1.5–4.4) or a totally damaged urethra (AOR: 6.3; 95 % CI: 3.0–13.0) were more likely to experience post-repair urinary incontinence than women who had their urethra intact. Conclusion At programmatic level in Guinea, caution should be paid to the repair of women who present with a damaged urethra and those who delivered vaginally as they carry greater risks of experiencing a failure of fistula closure and incontinence.
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Affiliation(s)
- Alexandre Delamou
- Ecole de Santé Publique, Université libre de Bruxelles (ULB), Bruxelles, Belgium. .,Centre national de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea. .,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Therese Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Abdoul Habib Beavogui
- Centre national de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Abdoulaye Toure
- Department of Public Health, Faculty of Medicine, University of Conakry, Conakry, Guinea
| | - Delphin Kolié
- Centre national de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Sidikiba Sidibé
- Centre national de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Department of Public Health, Faculty of Medicine, University of Conakry, Conakry, Guinea
| | - Mandian Camara
- Centre Médicosocial Jean Paul II de Conakry, Conakry, Guinea
| | | | | | | | - Alain Leveque
- Ecole de Santé Publique, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Wei-Hong Zhang
- Ecole de Santé Publique, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Delamou A, Delvaux T, Beavogui AH, Levêque A, Zhang WH, De Brouwere V. A descriptive longitudinal study protocol: recurrence and pregnancy post-repair of obstetric fistula in Guinea. BMC Pregnancy Childbirth 2016; 16:299. [PMID: 27724918 PMCID: PMC5057268 DOI: 10.1186/s12884-016-1101-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 10/07/2016] [Indexed: 12/01/2022] Open
Abstract
Background Obstetric fistula is a serious medical condition which affects women in low income countries. Despite the progress of research on fistula, there is little data on long term follow-up after surgical repair. The objective of this study is to analyse the factors associated with the recurrence of fistula and the outcomes of pregnancy following fistula repair in Guinea. Methods A descriptive longitudinal study design will be used. The study will include women who underwent fistula repair between 2012 and 2015 at 3 fistula repair sites supported by the Fistula Care Project in Guinea (Kissidougou Prefectoral Hospital, Labé Regional Hospital and Jean Paul II Hospital of Conakry). Participants giving an informed consent after a home visit by the Fistula Counsellors will be interviewed for enrolment at least 3 months after hospital discharge The study enrolment period is January 1, 2012 − June 30, 2015. Participants will be followed-up until June 30, 2016 for a maximum follow up period of 48 months. The sample size is estimated at 364 women. The cumulative incidence rates of fistula recurrence and pregnancy post-repair will be calculated using Kaplan-Meier methods and the risk factor analyses will be performed using adjusted Cox regression. The outcomes of pregnancy will be analysed using proportions, the Pearson’s Chi Square (χ2) and a logistic regression with associations reported as risk ratios with 95 % confidence intervals. All analyses will be done using STATA version 13 (STATA Corporation, College Station, TX, USA) with a level of significance set at P < 0.05. Discussion This study will contribute to improving the prevention and management of obstetric fistula within the community and support advocacy efforts for the social reintegration of fistula patients into their communities. It will also guide policy makers and strategic planning for fistula programs. Trial registration ClinicalTrials.gov Identifier: NCT02686957. Registered 12 February 2016 (Retrospectively registered).
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Affiliation(s)
- Alexandre Delamou
- Ecole de Santé Publique, Université libre de Bruxelles (ULB), Brussels, Belgium. .,Centre national de formation et de recherche en santé rurale de Maferinyah, Forecariah, Guinea. .,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Therese Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Woman and Child Health Research Centre, Institute of Tropical Medicine, Antwerp, Belgium
| | - Abdoul Habib Beavogui
- Centre national de formation et de recherche en santé rurale de Maferinyah, Forecariah, Guinea
| | - Alain Levêque
- Ecole de Santé Publique, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Wei-Hong Zhang
- Ecole de Santé Publique, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Woman and Child Health Research Centre, Institute of Tropical Medicine, Antwerp, Belgium
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28
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Delamou A, Utz B, Delvaux T, Beavogui AH, Shahabuddin A, Koivogui A, Levêque A, Zhang WH, De Brouwere V. Pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa: Scoping Review. Trop Med Int Health 2016; 21:1348-1365. [PMID: 27596732 DOI: 10.1111/tmi.12771] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To synthesise the evidence on pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa and to identify the existing knowledge gaps. METHODS A scoping review of studies reporting on pregnancy and childbirth in women who underwent repair for obstetric fistula in sub-Saharan Africa was conducted. We searched relevant articles published between 1 January 1970 and 31 March 2016, without methodological or language restrictions, in electronic databases, general Internet sources and grey literature. RESULTS A total of 16 studies were included in the narrative synthesis. The findings indicate that many women in sub-Saharan Africa still desire to become pregnant after the repair of their obstetric fistula. The overall proportion of pregnancies after repair estimated in 11 studies was 17.4% (ranging from 2.5% to 40%). Among the 459 deliveries for which the mode of delivery was reported, 208 women (45.3%) delivered by elective caesarean section (CS), 176 women (38.4%) by emergency CS and 75 women (16.3%) by vaginal delivery. Recurrence of fistula was a common maternal complication in included studies while abortions/miscarriage, stillbirths and neonatal deaths were frequent foetal consequences. Vaginal delivery and emergency C-section were associated with increased risk of stillbirth, recurrence of the fistula or even maternal death. CONCLUSION Women who get pregnant after repair of obstetric fistula carry a high risk for pregnancy complications. However, the current evidence does not provide precise estimates of the incidence of pregnancy and pregnancy outcomes post-repair. Therefore, studies clearly assessing these outcomes with the appropriate study designs are needed.
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Affiliation(s)
- Alexandre Delamou
- Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium. .,Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea. .,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Bettina Utz
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Therese Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Abdoul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea
| | - Asm Shahabuddin
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Akoi Koivogui
- Département Saône et Loire, Association de Dépistage Organisé des Cancers, Charnay-lès-Mâcon, France
| | - Alain Levêque
- Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
| | - Wei-Hong Zhang
- Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
| | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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29
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Phillips BS, Ononokpono DN, Udofia NW. Complicating causality: patient and professional perspectives on obstetric fistula in Nigeria. CULTURE, HEALTH & SEXUALITY 2016; 18:996-1009. [PMID: 26958903 DOI: 10.1080/13691058.2016.1148198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Obstetric fistula, a preventable maternal morbidity characterised by chronic bladder and/or bowel incontinence, is widespread in Nigeria. This qualitative, multi-site study examined the competing narratives on obstetric fistula causality in Nigeria. Research methods were participant observation and in-depth interviews with 86 fistula patients and 43 healthcare professionals. The study found that both patient and professional narratives identified limited access to medical facilities as a major factor leading to obstetric fistula. Patients and professionals beliefs regarding the access problem, however, differed significantly. The majority of fistula patients reported either delivering or attempting to deliver in medical facilities and most patients attributed fistula to a lack of trained medical staff and mismanagement at medical facilities. Conversely, a majority of health professionals believed that women developed obstetric fistula because they chose to deliver at home due to women's traditional beliefs about womanhood and childbirth. Both groups described financial constraints and inadequate transport to medical facilities during complicated labour as related to obstetric fistula onset. Programmatic insights derived from these findings should inform fistula prevention interventions both with healthcare professionals and with Nigerian women.
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Affiliation(s)
- Beth S Phillips
- a Department of Public Health , University of Calabar , Calabar , Nigeria
- b Department of Medicine , University of California-San Francisco , San Francisco , CA , USA
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30
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Maheu-Giroux M, Filippi V, Maulet N, Samadoulougou S, Castro MC, Meda N, Pouliot M, Kirakoya-Samadoulougou F. Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey data. BMC Pregnancy Childbirth 2016; 16:82. [PMID: 27098261 PMCID: PMC4839076 DOI: 10.1186/s12884-016-0871-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data. METHODS We pooled all available Demographic and Health Surveys and Multiple Indicators Cluster Surveys carried out in sub-Saharan Africa that collected information on VF symptoms. Bayesian matched logistic regression models that accounted for the imperfect sensitivity and specificity of self-reports of VF symptoms were used for effect size estimation. RESULTS Up to 27 surveys were pooled, including responses from 332,889 women. Being able to read decreased the odds of VF by 13% (95% Credible Intervals (CrI): 1% to 23%), while higher odds of VF symptoms were observed for women of short stature (<150 cm) (Odds Ratio (OR) = 1.31; 95% CrI: 1.02-1.68), those that had experienced intimate partner sexual violence (OR = 2.13; 95% CrI: 1.60-2.86), those that reported sexual debut before the age of 14 (OR = 1.41; 95% CrI: 1.16-1.71), and those that reported a first birth before the age of 14 (OR = 1.39; 95% CrI: 1.04-1.82). The effect of post-primary education, female genital mutilation, and having problems obtaining permission to seek health care were not statistically significant. CONCLUSIONS Increasing literacy, delaying age at first sex/birth, and preventing sexual violence could contribute to the elimination of obstetric fistula. Concomitant improvements in access to quality sexual and reproductive healthcare are, however, required to end fistula in sub-Saharan Africa.
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Affiliation(s)
- Mathieu Maheu-Giroux
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, London, UK
| | - Véronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nathalie Maulet
- Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-champs, Brussels, Belgium
| | - Sékou Samadoulougou
- Pôle Épidemiologie et Biostatistique, Institute de recherche expérimentale et Clinique, Université Catholique de Louvain, Clos Chapelle-aux-champs, Brussels, Belgium
| | - Marcia C Castro
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Nicolas Meda
- Centre Muraz, Ministry of Health, Bobo-Dioulasso, Burkina Faso.,UFR Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Mariève Pouliot
- Institute of Food and Resources Economics, Section for Global Development, University of Copenhagen, Copenhagen, Denmark
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31
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Byamugisha J, El Ayadi A, Obore S, Mwanje H, Kakaire O, Barageine J, Lester F, Butrick E, Korn A, Nalubwama H, Knight S, Miller S. Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol. Reprod Health 2015; 12:115. [PMID: 26683687 PMCID: PMC4683951 DOI: 10.1186/s12978-015-0100-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/16/2015] [Indexed: 12/04/2022] Open
Abstract
Background Obstetric fistula is a debilitating birth injury that affects an estimated 2–3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65–95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. Methods This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. Discussion This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.
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Affiliation(s)
- Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda. .,Mulago National Referral and Teaching Hospital, Kampala, Uganda.
| | - Alison El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
| | - Susan Obore
- Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Haruna Mwanje
- Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Felicia Lester
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
| | - Elizabeth Butrick
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sharon Knight
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
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Watt MH, Wilson SM, Sikkema KJ, Velloza J, Mosha MV, Masenga GG, Bangser M, Browning A, Nyindo PM. Development of an intervention to improve mental health for obstetric fistula patients in Tanzania. EVALUATION AND PROGRAM PLANNING 2015; 50:1-9. [PMID: 25710896 PMCID: PMC4395537 DOI: 10.1016/j.evalprogplan.2015.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/26/2015] [Accepted: 01/31/2015] [Indexed: 06/04/2023]
Abstract
Obstetric fistula is a debilitating childbirth injury that has been associated with high rates of psychological distress. Global efforts have helped to link women to surgical repair, but thus far no evidence-based interventions exist to address the psychological needs of these women during the hospital stay. In this paper, we describe the development of a psychological intervention for women in Tanzania who are receiving surgical care for an obstetric fistula. The intervention was developed based on theories of cognitive behavioral therapy and coping models. Content and delivery were informed by qualitative data collection with a range of stakeholders including women with fistula, and input from a study advisory board. The resulting intervention was six individual sessions, delivered by a trained community health nurse. The session topics were (1) recounting the fistula story; (2) creating a new story about the fistula; (3) loss, grief and shame; (4) specific strategies for coping; (5) social relationships; and (6) planning for the future. A trial run of the intervention revealed that the intervention could be delivered with fidelity and was acceptable to patients. A future randomized control trial will evaluate the efficacy of this intervention to address the mental health symptoms of this population.
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Affiliation(s)
| | - Sarah M Wilson
- Duke Global Health Institute, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Kathleen J Sikkema
- Duke Global Health Institute, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | | | - Mary V Mosha
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Gileard G Masenga
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Andrew Browning
- Maternity Africa, Arusha, Tanzania; Selian Lutheran Hospital, Arusha, Tanzania
| | - Pilli M Nyindo
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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33
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Delamou A, Diallo M, Beavogui AH, Delvaux T, Millimono S, Kourouma M, Beattie K, Barone M, Barry TH, Khogali M, Edginton M, Hinderaker SG, Ruminjo J, Zhang WH, De Brouwere V. Good clinical outcomes from a 7-year holistic programme of fistula repair in Guinea. Trop Med Int Health 2015; 20:813-9. [PMID: 25706671 PMCID: PMC4672702 DOI: 10.1111/tmi.12489] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country. Methods This was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014. Results The majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3 months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up. Conclusion Routine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula. Objectifs La fistule génitale féminine reste un problème de santé publique dans les pays en développement. De janvier 2007 à septembre 2013, le projet Fistula Care, géré par Engender Health en partenariat avec le Ministère de la Santé et soutenu par l’USAID, a intégré les services de réparation de fistules dans les maternités des hôpitaux généraux en Guinée. L'objectif de cet article est de présenter et de discuter les résultats cliniques de sept années de travail impliquant 2116 femmes traitées dans trois hôpitaux à travers le pays. Méthodes Il s'agit d'une étude de cohorte rétrospective utilisant des données extraites des dossiers médicaux de réparations de fistules menées de 2007 à 2013. Les données de l’étude ont été analysées au cours de la période allant d'avril à août 2014. Résultats La majorité des 2116 femmes qui ont subi une réparation chirurgicale avaient une fistule vésico vaginale (n = 2 045, 97%) et 3% avaient une fistule recto vaginale ou une combinaison des deux. Au total, 1748 (83%) femmes ont eu leur fistule refermée et sont devenues continentes d'urine immédiatement après la chirurgie. À la sortie, 1795 femmes (85%) avaient une fistule fermée et 1680 (79%) étaient sèches, c'est à dire qu'elles n'avaient plus de fuite d'urine et/ou de matières fécales. 115 (5%) femmes avaient toujours une incontinence résiduelle malgré la fermeture de la fistule. Le suivi à trois mois a été complété par 1663 (79%) femmes dont 1405 (84,5%) ont eu leur fistule fermée et 80% étaient continentes. 21% ont été perdues au suivi. Conclusion La réparation programmatique de routine de la fistule obstétricale dans les régions à faibles ressources peut donner de bons résultats. Toutefois, davantage d'efforts sont nécessaires pour remédier à la perte au suivi, maintenir les résultats et prévenir l'apparition et/ou la réapparition de fistules. Objetivos La fístula genital femenina continúa siendo una preocupación de salud pública en países en vías de desarrollo. Entre Enero 2007 y Septiembre 2013, el proyecto Fistula Care, manejado por EngenderHealth junto con el Ministerio de Salud de Guinea, y financiado por USAID, integró los servicios de reparación de fistula en las maternidades de hospitales generales en Guinea. El objetivo de este artículo es presentar y discutir los resultados clínicos de 7 años de trabajo con 2116 mujeres intervenidas en tres hospitales del país. Métodos Estudio retrospectivo de cohortes utilizando datos tomados de historias clínicas de reparaciones de fístula realizadas entre el 2007 y el 2013. Los datos del estudio se revisaron durante el periodo entre Abril y Agosto 2014. Resultados La mayoría de las 2116 mujeres que se sometieron a la reparación quirúrgica tenían una fistula vesico-vaginal (n = 2045, 97%) y 3% tenían una fístula recto-vaginal o una combinación de ambas. En general, 1748 (83%) tenían la fístula cerrada y eran continentes inmediatamente después de la cirugía. En el momento del alta, 1795 mujeres (85%) tenían la fistula cerrada y 1680 (79%) estaban secas, es decir que ya no perdían orina y/o heces. 115 (5%) continuaron teniendo incontinencia residual a pesar de que la fistula estaba cerrada. El seguimiento a los tres meses se completó para 1663 (79%) mujeres, de las cuales 1405 (84.5%) tenían la fistula cerrada y 80% eran continentes. Un 21% fueron perdidas durante el seguimiento. Conclusión La reparación rutinaria programada de la fístula obstétrica en lugares con pocos recursos puede dar buenos resultados. Sin embargo, se requieren más esfuerzos para resolver la pérdida durante el seguimiento, mantener los resultados y prevenir la aparición y/o reaparición de la fístula.
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Affiliation(s)
- Alexandre Delamou
- Ecole de Santé Publique, Université libre de Bruxelles, Bruxelles, Belgium; Centre national de formation et de recherche en santé rurale de Maferinyah, Forecariah, Guinea; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Lombard L, de St Jorre J, Geddes R, El Ayadi AM, Grant L. Rehabilitation experiences after obstetric fistula repair: systematic review of qualitative studies. Trop Med Int Health 2015; 20:554-568. [PMID: 25640771 DOI: 10.1111/tmi.12469] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To synthesise evidence on women's experiences surrounding rehabilitation and reintegration after obstetric fistula repair in sub-Saharan Africa and explore recommendations from women and health service providers. METHOD Systematic literature review of qualitative studies surrounding rehabilitation experiences of women in sub-Saharan Africa who have undergone obstetric fistula repair. Using a pre-defined search strategy, seven databases, relevant source publications and grey literature were searched for primary qualitative studies. Data from ten studies were collected, and thematic analysis based on the framework approach was used to analyse the findings. RESULTS The most important rehabilitating factor for women was fulfilment of social roles. Health service perspectives were more frequent than women's perspectives. Counselling and health education were the most common recommendations from both perspectives. CONCLUSION Little qualitative evidence is available on rehabilitation after obstetric fistula repair in sub-Saharan Africa. Counselling services and community health education are priorities. Further research should emphasise women's perspectives to better inform interventions aimed at addressing the physical and social consequences of obstetric fistula.
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Affiliation(s)
- Ladeisha Lombard
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jenna de St Jorre
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Rosemary Geddes
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.,NHS Health Scotland, Edinburgh, UK
| | - Alison M El Ayadi
- Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Liz Grant
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Lawani LO, Iyoke CA, Ezeonu PO. Contraceptive practice after surgical repair of obstetric fistula in southeast Nigeria. Int J Gynaecol Obstet 2015; 129:256-9. [PMID: 25728480 DOI: 10.1016/j.ijgo.2014.11.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/23/2014] [Accepted: 02/03/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the contraceptive practices of women after surgical repair of obstetric fistula and to assess determinants of uptake and the pregnancy rate in the first year. METHODS A prospective cohort study enrolled women who had a successful surgical repair of obstetric fistula at a center in Nigeria between 2011 and 2013. Patients were followed up for 1year. Data were obtained through record review and completion of a semi-structured questionnaire. RESULTS Among 188 participants, 180 (95.7%) were aware of contraception, but only 70 (37.2%) used contraceptive methods after surgery. The most commonly used methods were the male condom (50 [71.4%] of 70) and hormonal injections (14 [20.0%]). The main reasons for non-use were fear of adverse effects (48 [40.7%] of 118 women), future desire for more children (35 [29.7%]), religious prohibition (26 [22.0%]), cultural beliefs (29 [24.6%]), and partner disapproval (42 [35.6%]). The risk of unplanned pregnancy in the first year was significantly lower among women who used contraceptives than among those who did not (relative risk 0.14, 95% confidence interval 0.02-1.06; P=0.03). CONCLUSION Contraceptive uptake for birth control after fistula repair surgery was low because of socioeconomic reasons, religious and cultural beliefs, and myths, resulting in unplanned pregnancies.
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Affiliation(s)
- Lucky O Lawani
- School of Post Graduate Studies, Department of Community Medicine, University of Nigeria, Enugu, Nigeria.
| | - Chukwuemeka A Iyoke
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Paul O Ezeonu
- Department of Obstetrics and Gynecology, Federal Teaching Hospital Abakaliki, Abakaliki, Nigeria
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Tunçalp Ö, Tripathi V, Landry E, Stanton CK, Ahmed S. Measuring the incidence and prevalence of obstetric fistula: approaches, needs and recommendations. Bull World Health Organ 2014; 93:60-2. [PMID: 25558110 PMCID: PMC4271685 DOI: 10.2471/blt.14.141473] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Özge Tunçalp
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Vandana Tripathi
- Fistula Care Plus, EngenderHealth, New York, United States of America (USA)
| | - Evelyn Landry
- Fistula Care Plus, EngenderHealth, New York, United States of America (USA)
| | - Cynthia K Stanton
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Raassen TJIP, Ngongo CJ, Mahendeka MM. Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries. Int Urogynecol J 2014; 25:1699-706. [PMID: 25062654 PMCID: PMC4234894 DOI: 10.1007/s00192-014-2445-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Genitourinary fistula poses a public health challenge in areas where women have inadequate access to quality emergency obstetric care. Fistulas typically develop during prolonged, obstructed labor, but providers can also inadvertently cause a fistula when performing obstetric or gynecological surgery. METHODS This retrospective study analyzes 805 iatrogenic fistulas from a series of 5,959 women undergoing genitourinary fistula repair in 11 countries between 1994 and 2012. Injuries fall into three categories: ureteric, vault, and vesico-[utero]/-cervico-vaginal. This analysis considers the frequency and characteristics of each type of fistula and the risk factors associated with iatrogenic fistula development. RESULTS In this large series, 13.2 % of genitourinary fistula repairs were for injuries caused by provider error. A range of cadres conducted procedures resulting in iatrogenic fistula. Four out of five iatrogenic fistulas developed following surgery for obstetric complications: cesarean section, ruptured uterus repair, or hysterectomy for ruptured uterus. Others developed during gynecological procedures, most commonly hysterectomy. Vesico-[utero]/-cervico-vaginal fistulas were the most common (43.6 %), followed by ureteric injuries (33.9 %) and vault fistulas (22.5 %). One quarter of women with iatrogenic fistulas had previously undergone a laparotomy, nearly always a cesarean section. Among these women, one quarter had undergone more than one previous cesarean section. CONCLUSIONS Women with previous cesarean sections are at an increased risk of iatrogenic injury. Work environments must be adequate to reduce surgical error. Training must emphasize the importance of optimal surgical techniques, obstetric decision-making, and alternative ways to deliver dead babies. Iatrogenic fistulas should be recognized as a distinct genitourinary fistula category.
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Clinical procedures and practices used in the perioperative treatment of female genital fistula during a prospective cohort study. BMC Pregnancy Childbirth 2014; 14:220. [PMID: 24996561 PMCID: PMC4091747 DOI: 10.1186/1471-2393-14-220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
Background Treatment and care for female genital fistula have become increasingly available over the last decade in countries across Africa and South Asia. Before the International Federation of Gynaecology and Obstetrics (FIGO) and partners published a global fistula training manual in 2011 there was no internationally recognized, standardized training curriculum, including perioperative care. The community of fistula care practitioners and advocates lacks data about the prevalence of various perioperative clinical procedures and practices and their potential programmatic implications are lacking. Methods Data presented here are from a prospective cohort study conducted between September 2007 and September 2010 at 11 fistula repair facilities supported by Fistula Care in five countries. Clinical procedures and practices used in the routine perioperative management of over 1300 women are described. Results More than two dozen clinical procedures and practices were tabulated. Some of them were commonly used at all sites (e.g., vaginal route of repair, 95.3% of cases); others were rare (e.g., flaps/grafts, 3.4%) or varied widely depending on site (e.g. for women with urinary fistula, the inter-quartile range for median duration of post-repair bladder catheterization was 14 to 29 days). Conclusions These findings show a wide range of clinical procedures and practices with different program implications for safety, efficacy, and cost-effectiveness. The variability indicates the need for further research so as to strengthen the evidence base for fistula treatment in developing countries.
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Heller A. Bedside manner and the invisible patient: The silence surrounding women's gynaecological health in Niger (Respond to this article at http://www.therai.org.uk/at/debate). ANTHROPOLOGY TODAY 2014. [DOI: 10.1111/1467-8322.12086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alison Heller
- Doctoral candidate in the Department of Anthropology at Washington University in St. Louis
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