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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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Wilson SF, Alway J, Hotchkiss E, Aluku C, Matityahu D, Mabeya H, El Ayadi AM. Fertility desires and sexual behaviours among women recovering from genital fistula repair in Eldoret, Kenya. Trop Med Int Health 2024; 29:144-151. [PMID: 38069534 DOI: 10.1111/tmi.13959] [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] [Indexed: 02/07/2024]
Abstract
OBJECTIVES The reproductive desire of women following genital fistula repair surgery is complex, varied and often not addressed, although it carries significant consequences. The aim of this study was to better understand the fertility desires and sexual behaviours of women who recently underwent surgical repair of a genital fistula. METHODS This is a secondary analysis of a retrospective cohort study designed to assess the effectiveness of Beyond Fistula, a reintegration programme for women recovering from genital fistula surgery in Eldoret, Kenya. One hundred women who participated in the Beyond Fistula programme between 2013 and 2019 were interviewed in person regarding future fertility desire, current sexual behaviour and contraceptive use. RESULTS Among the 79 reproductive-aged women included in this study, 63.3% reported no future desire for pregnancy. Those that desired another pregnancy were significantly younger (48.3% were 18-29 years old vs. 66.0% were 35 years old or more, p = 0.004), had fewer living children (70% had 0-2 children vs. 56% had 3 or more children, p < 0.001), and a lower level of food insecurity (27.6% reported no to marginal insecurity vs. 14%, p = 0.014). Current sexual activity was marginally different between women who did and did not desire future pregnancy (82.8% vs. 66.0%, p = 0.053). Of the 50 women in our study who did not desire pregnancy, 62.0% were sexually active and of these, only 38.7% were preventing pregnancy. Lack of knowledge and access to methods were most commonly cited as barriers to use. CONCLUSIONS Many women recovering from genital fistula surgery do not desire pregnancy and are sexually active but are not using a method to prevent pregnancy. The potential for post-surgical reintegration programmes to address education and access to contraception is a vital and unmet need to promote reproductive empowerment in this population of women as they reestablish their lives.
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Affiliation(s)
| | - Jessica Alway
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Emily Hotchkiss
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Carolyne Aluku
- Gynocare Women's and Fistula Hospital, Eldoret National Polytechnic, Eldoret, Kenya
| | - Debra Matityahu
- Department of Obstetrics and Gynecology, Kaiser Permanente Redwood City, Redwood City, California, USA
| | - Hillary Mabeya
- Department of Reproductive Health, Moi University School of Medicine, Gynocare Women's and Fistula Hospital, Eldoret, Kenya
| | - Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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Gondwe MS, Maharaj P, Sewpersad S. The reintegration of obstetric fistula survivors in Malawi: Perspectives of healthcare providers. Midwifery 2023; 126:103834. [PMID: 37782973 DOI: 10.1016/j.midw.2023.103834] [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: 02/15/2023] [Revised: 07/13/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE In Malawi, women face a high risk of obstetric fistulas. There are many socio-cultural implications for women suffering from the condition, many of which continue to affect them even after they have undergone treatment and attempt to reintegrate into their lives. The focus of this study was to explore the socio-cultural factors that influence the reintegration of obstetric fistula survivors in Malawi from the perspectives of healthcare providers. DESIGN This qualitative study was conducted at a hospital in Central Malawi, which houses a non-governmental organization (NGO) that is wholly dedicated to the treatment and reintegration of obstetric fistula patients and survivors. In total, in-depth interviews was conducted with 15 healthcare providers. FINDINGS After surgery, survivors are given economic and social empowerment assistance to allow them to gain independence from their families. Counselling interventions help patients overcome their isolation and depression so they may begin to interact with others. In some circumstances, the initial surgeries may be unsuccessful, causing anxiety and doubt among the women. Some survivors no longer desired to bear children in the future, which negatively impacted their marriages and social status. KEY CONCLUSION It is imperative to overcome the socio-cultural beliefs that impact the treatment of obstetric fistula. The perspectives of healthcare providers involved in obstetric fistula treatment can assist policy makers to conceptualize and implement effective policies and programmes that will improve the quality of care offered to obstetric fistula survivors after their treatment. IMPLICATIONS FOR PRACTICES These first-hand experiences and knowledge of healthcare providers are significant in identifying challenges and barriers that fistula survivors encounter during the reintegration process.
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Affiliation(s)
- Mwawi S Gondwe
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Sachin Sewpersad
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa.
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El Ayadi AM, Nalubwama H, Miller S, Mitchell A, Korn AP, Chen CCG, Byamugisha J, Painter C, Obore S, Barageine JK. Women's sexual activity and experiences following female genital fistula surgery. J Sex Med 2023; 20:633-644. [PMID: 36892111 PMCID: PMC10149378 DOI: 10.1093/jsxmed/qdad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Surgical repair has a transformative impact on the lives of women affected by female genital fistula; however, various physical, social, and economic challenges may persist postrepair and prevent complete reengagement in relationships and communities. Nuanced investigation of these experiences is needed to inform programming that aligns with women's reintegration needs. AIM We investigated the sexual activity resumption, experiences, and concerns of women in Uganda during the year following genital fistula repair surgery. METHODS Women were recruited from Mulago Hospital between December 2014 and June 2015. We collected data at baseline and 4 times postsurgery about sociodemographic characteristics and physical/psychosocial status; we also assessed sexual interest and satisfaction twice. We performed in-depth interviews with a subset of participants. We analyzed quantitative findings via univariate analyses, and qualitative findings were coded and analyzed thematically. OUTCOMES We assessed sexual readiness, fears, and challenges following surgical repair of female genital fistula using quantitative and qualitative measures of sexual activity, pain with sex, sexual interest/disinterest, and sexual satisfaction/dissatisfaction. RESULTS Among the 60 participants, 18% were sexually active at baseline, which decreased to 7% postsurgery and increased to 55% at 1 year after repair. Dyspareunia was reported by 27% at baseline and 10% at 1 year; few described leakage during sex or vaginal dryness. Qualitative findings showed wide variance of sexual experiences. Some reported sexual readiness quickly after surgery, and some were not ready after 1 year. For all, fears included fistula recurrence and unwanted pregnancy. CONCLUSION These findings suggest that postrepair sexual experiences vary widely and intersect meaningfully with marital and social roles following fistula and repair. In addition to physical repair, ongoing psychosocial support is needed for comprehensive reintegration and the restoration of desired sexuality. HIGHLIGHTS
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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 94158, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Ashley Mitchell
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Abner P Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21218, United States
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Caitlyn Painter
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
- Urogynecology Division, Department of Obstetrics and Gynecology, Kaiser Permanente, Oakland, CA 94611, United States
| | - Susan Obore
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
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Morgan R, Asiimwe L, Ager AL, Haq Z, Thumba L, Shcherbinina D. Rehabilitation services must include support for sexual and gender-based violence survivors in Ukraine and other war- and conflict-affected countries. Health Policy Plan 2023; 38:417-419. [PMID: 36658716 DOI: 10.1093/heapol/czad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/16/2022] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
Sexual and gender-based violence (SGBV)-both during times of war and peace-can have impactful negative social and health outcomes. Reports of rape being used as an act of war in Ukraine are drawing global attention to the need for specialized care for SGBV survivors during times of war and thereafter. While data remain limited, in 3 November 2022, 7 million people in Ukraine were reported to need SGBV prevention and response services. Services offered by the government and civil society include a coordination centre of free legal aid, online and mobile platforms, chat-bots, hotlines, assistance centres, shelters, crisis rooms and mobile brigades. Rehabilitation services to support women and girls who have experienced SGBV during times of conflict and war, however, remain limited. We must make sure that our understanding of rehabilitation extends beyond providing physical modalities or recovery after surgery and that SGBV survivors are not excluded from necessary care. This is particularly important if we want to ensure that rehabilitation services are meeting the needs of the most vulnerable populations. We call on the international rehabilitation community to ensure the availability of and access to these vital life-changing services.
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Affiliation(s)
- Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | - Lillian Asiimwe
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Amanda L Ager
- Physiopedia, Bates Wells Braithwaite, Thames Exchange, 10 Queen Street Place, London EC4R 1BE, United Kingdom
| | - Zuhra Haq
- Humanity and Inclusion, Sector G - 9/1, Plot 1 B, Bazar 1, Class III Commercial Plaza, Islamabad 44000, Pakistan
| | - Linda Thumba
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
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Bulndi LB, Ireson D, Adama E, Bayes S. Sub-Saharan African women's views and experiences of risk factors for obstetric fistula: a qualitative systematic review. BMC Pregnancy Childbirth 2022; 22:680. [PMID: 36057559 PMCID: PMC9440544 DOI: 10.1186/s12884-022-05013-2] [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: 06/10/2021] [Accepted: 08/26/2022] [Indexed: 11/14/2022] Open
Abstract
Background Obstetric fistula used as synonymous with VVF in this study, is an abnormal communication/hole between the urinary tract and the genital tract or the gastrointestinal tract and the genital tract, resulting from prolonged obstructed labour. VVF may cause sufferers to experience chronic urinary/faecal incontinence, and the stigma of continuing foul odour. VVF is primarily caused by prolonged obstructed labour, which is brought about by a range of causes. Recently, it has been proposed that women’s groups and fistula survivors should suggest interventions to reduce or prevent the incidence of obstetric fistula. Objective The objective of this review was to synthesise what is reported about women’s views and experiences of the risk factors underlying the causes of VVF. Methods A systematic approach outlined in the Joanna Briggs Institute Manual for Evidence synthesis was followed for this review, articles published since the last 11 years from 2011 to 2021 were selected against several criteria and critically appraised using JBI Critical Appraisal Checklist for qualitative studies. Results Nine studies were retained for inclusion in this review and the data were then synthesised into five themes: (1) Cultural beliefs and practices impeding safe childbirth, (2) Lack of woman’s autonomy in choices of place to birth safely, (3) Lack of accessibility and social support to safe childbirth, (4) Inexperienced birth attendants and, (5) Delayed emergency maternal care (childbirth). Conclusions This review highlights the complexity of risk factors predisposing women to the known causes of VVF. It also illuminates the absence of women’s voices in the identification of solutions to these risks. Women are most directly affected by VVF. Therefore, their knowledge, views, and experiences should be considered in the development and implementation of strategies to address the issue. Exploring women’s views on this issue would enable the identification of gaps in maternity care provision, which would be of interest to community and health service leaders as well as policymakers in Sub-Saharan Africa. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05013-2.
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Affiliation(s)
- Lydia Babatunde Bulndi
- Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia. .,The Centre Evidence Informed Nursing, Midwifery and Health Care Practice; 270 Joondalup Drive, Joondalup, WA: A JBI Affiliated Group, Joondalup, Australia.
| | - Deborah Ireson
- Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,The Centre Evidence Informed Nursing, Midwifery and Health Care Practice; 270 Joondalup Drive, Joondalup, WA: A JBI Affiliated Group, Joondalup, Australia
| | - Esther Adama
- Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,The Centre Evidence Informed Nursing, Midwifery and Health Care Practice; 270 Joondalup Drive, Joondalup, WA: A JBI Affiliated Group, Joondalup, Australia
| | - Sara Bayes
- Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,The Centre Evidence Informed Nursing, Midwifery and Health Care Practice; 270 Joondalup Drive, Joondalup, WA: A JBI Affiliated Group, Joondalup, Australia.,School of Nursing, Midwifery, and Paramedicine (Melbourne), Australian Catholic University, 115 Victoria Parade Fitzroy, Victoria, Melbourne, 3065, Australia
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Nwala EK, Nwaigwe C, Sripad P, Warren CE, Ishaku S, Kongyamba S. Exploring awareness of obstetric fistula in Eastern and Northern Nigeria: perceived causes, symptoms, and availability of treatment services. Glob Health Res Policy 2022; 7:29. [PMID: 35978399 PMCID: PMC9387019 DOI: 10.1186/s41256-022-00264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/10/2022] [Indexed: 12/05/2022] Open
Abstract
Background Evidence suggests that there are approximately two female genital fistula cases per 1000 women of reproductive age in sub-Saharan Africa. It is estimated that more than 200,000 women are affected by fistula in Nigeria, primarily due to obstetric causes. Awareness has been indicated as a risk factor for the development of obstetric fistula. This study explored the awareness of obstetric fistula such as causes, symptoms, and availability of and access to treatment services in southeastern and northwestern Nigeria.
Methods An exploratory qualitative study design was used to conduct this research in Kano and Ebonyi states in northern and eastern Nigeria, respectively. A total of six (6) focus group discussions were conducted with three categories of participants: women who were successfully repaired and discharged (n = 2), community-married men (n = 2), and women (n = 2). Forty-four (44) In-depth interviews were conducted three categories of participants: 18 with women with fistula who were either awaiting repair or had been repaired; 6 family member caregivers accompanying fistula patients, and 20 health service providers at fistula repair centers. We developed a data analysis plan based on the emerging themes. The transcripts and field notes were imported into QSR Nvivo version 11 and coded accordingly. Content and thematic analysis was run by inductively drawing themes based on the elicited information from participants.
Results There was lack of knowledge of obstetric fistula and its causes among married men and women in the community, caregivers, and some patients were unaware of what caused their fistula for years. In this study, none of the community men and women nor caregivers correctly identified the causes and symptoms of a fistula or knew where to seek treatment. Knowledge about fistula was more common among women who had undergone repairs. Some repaired women attributed the cause of fistula to the providers who attended to them during delivery. Conclusions Findings reveal a widespread lack of awareness of obstetric fistula onset and awareness of the availability of repair services at the community level. There is an urgent need to explore multi-pronged strategies for increasing awareness of obstetric fistula and available treatment services among women and other community members.
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Affiliation(s)
- Emmanuel Kelechi Nwala
- Maternal, Newborn and Child Health, Population Council, Nigeria, House 4, No 16 Mafemi Crescent, Off Solomon Lar Way, Utako, Abuja, Nigeria.
| | - Charles Nwaigwe
- Maternal, Newborn and Child Health, Population Council, Nigeria, House 4, No 16 Mafemi Crescent, Off Solomon Lar Way, Utako, Abuja, Nigeria
| | | | | | - Salisu Ishaku
- Maternal, Newborn and Child Health, Population Council, Nigeria, House 4, No 16 Mafemi Crescent, Off Solomon Lar Way, Utako, Abuja, Nigeria
| | - Solomon Kongyamba
- Maternal, Newborn and Child Health, Population Council, Nigeria, House 4, No 16 Mafemi Crescent, Off Solomon Lar Way, Utako, Abuja, Nigeria
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Nembunzu D, Mayemba N, Sidibé S, Grovogui FM, Aussak BTT, Banze Kyongolwa DF, Camara BS, Tripathi V, Delamou A. Factors Associated With Persistent Urinary Incontinence Among Women Undergoing Female Genital Fistula Surgery in the Democratic Republic of Congo From 2017 to 2019. Front Glob Womens Health 2022; 3:896991. [PMID: 35814834 PMCID: PMC9263387 DOI: 10.3389/fgwh.2022.896991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite high closure rates, residual urinary incontinence remains a common problem after successful closure of a vesico-vaginal fistula. The objective of this study was to identify factors associated with residual urinary incontinence in women with successful fistula closure in sites supported by the Fistula Care Plus project in the Democratic Republic of Congo (DRC). Material and Methods This was a retrospective cohort study using routine data extracted from the medical records of women undergoing fistula surgery in three hospitals supported by the Fistula Care Plus project in DRC between 2017 and 2019. We analyzed factors associated with residual urinary incontinence among a subsample of women with closed fistula at discharge. We collected data on sociodemographic, clinical, gynecological-obstetrical characteristics, and case management. Univariate and multivariate analyses were performed to determine the factors associated with residual urinary incontinence. Results Overall, 31 of 718 women discharged with closed fistula after repair (4.3%; 95% CI: 3.1–6.1) had residual incontinence. The leading causes identified in these women with residual incontinence were urethral voiding (6 women), short urethra (6 women), severe fibrosis (3 women) and micro-bladder (2 women). The prevalence of residual incontinence was higher among women who received repair at the Heal Africa (6.6%) and St Joseph's (3.7%) sites compared with the Panzi site (1.7%). Factors associated with increased odds of persistent urinary incontinence were the Heal Africa repair site (aOR: 54.18; 95% CI: 5.33–550.89), any previous surgeries (aOR: 3.17; 95% CI: 1.10–9.14) and vaginal surgical route (aOR: 6.78; 95% CI: 1.02–45.21). Conclusion Prior surgery and repair sites were the main predictors of residual incontinence after fistula closure. Early detection and management of urinary incontinence and further research to understand site contribution to persistent incontinence are needed.
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Affiliation(s)
- Dolores Nembunzu
- Fistula Clinic, Department of Gynecology and Obstetrics, Saint Joseph Hospital, Kinshasa, Democratic Republic of Congo
| | - Naomie Mayemba
- Fistula Clinic, Department of Gynecology and Obstetrics, Saint Joseph Hospital, Kinshasa, Democratic Republic of Congo
| | - Sidikiba Sidibé
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
- *Correspondence: Sidikiba Sidibé
| | - Fassou Mathias Grovogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | | | - Bienvenu Salim Camara
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
| | | | - Alexandre Delamou
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
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Gladstone TRG, Ugueto AM, Muleta M, Meshesha TM, Ambaafris GG, Patwa MC, Zhong C, Buchholz KR. Development and Pilot Test of a Group Cognitive Behavioral Intervention for Women Recovering From Fistula Repair Surgery in Ethiopia. Front Public Health 2022; 10:862351. [PMID: 35734763 PMCID: PMC9207711 DOI: 10.3389/fpubh.2022.862351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Obstetric fistula is a serious complication that affects thousands of women in low-income countries. Women who suffer from obstetric fistulae are at risk of developing mental health problems, but to date most interventions have focused on repairing the physical consequences of fistulae through surgery. The goal of the current study is to develop an evidence-based intervention targeting symptoms of depression, anxiety, and trauma in women recovering from fistula repair surgery. First, hospital staff and patients awaiting surgery at a fistula hospital in Ethiopia participated in qualitative interviews to provide information on the mental health needs of women with fistulae, how the hospital tends to these women's psychological needs, and the training needs of staff members. Data from these interviews were used to develop the COFFEE intervention (CBT with Obstetric Fistula for Education and Empowerment). COFFEE is a modular, group intervention that teaches psycho-education, behavioral activation, relaxation, problem solving, cognitive restructuring, and includes a trauma narrative. Patients then participated in an open trial of the COFFEE intervention at the University of Gondar Hospital. Five separate groups were conducted with 24 women who were enrolled post-fistula repair surgery. Women completed pre-treatment self-report questionnaires, participated in group sessions conducted by nurses (with 8 sessions delivered across 10–14 days), and were assessed post-treatment and at 3-month follow-up. Results indicate a significant reduction on depression and anxiety symptoms scores across the three time points [F(2, 40) = 68.45, p < 0.001 partial η2 = 0.774]. Additionally, there was a significant decrease in traumatic stress scores from baseline to post-treatment [F(1.10, 21.98) = 100.51, p < 0.001 partial η2 = 0.834]. Feedback forms completed by nurses and patients suggest the intervention was well-received. Results of this open-trial suggest the COFFEE intervention is feasible, acceptable, and clinically beneficial to treat symptoms of depression, anxiety, and traumatic stress in women post-fistula repair surgery in a hospital setting.
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Affiliation(s)
- Tracy R. G. Gladstone
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, United States
- *Correspondence: Tracy R. G. Gladstone
| | - Ana M. Ugueto
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Tsega M. Meshesha
- MIT Center for Biomedical Innovation, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Genet G. Ambaafris
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mariya C. Patwa
- School of Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Cordelia Zhong
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, United States
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Long-Term Effects of Obstetric Fistula on the Overall Quality of Life among Survivors Who Had Undergone Obstetric Fistula Repair, Central Gondar Zone, Northwest Ethiopia, 2020: A Community-Based Study. Rehabil Res Pract 2022; 2022:6703409. [PMID: 35178255 PMCID: PMC8846977 DOI: 10.1155/2022/6703409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Childbirth is a special time in the lives of women and families at large. It can also be a time of great tragedy. International reports show that, annually, more than 500,000 women die from pregnancy and childbirth complications globally. For every woman who dies in childbirth, majorities remain alive, but scarred by permanent disabilities. Obstetric fistula is, without a doubt, the most severe of pregnancy-related disabilities. Objective. This research is aimed at assessing the long-term effects of obstetric fistula on the overall quality of life among fistula survivors in central Gondar zone. Methods. A community-based cross-sectional study was conducted among women who had undergone obstetric fistula repair, 1-4 years after the surgery, in the central Gondar zone. The participants were reached through appointments that were made by the researchers using census approach after having the participants’ contact lists (specific residence and cell phone numbers), and research interviews have taken place at the respondents’ home or residence using an adapted and validated tool. Data entry and analysis were done using Epi Info version 7 and SPSS version 20, respectively. Results. A total of 182 fistula survivors were interviewed giving a 94.8% response rate. This study indicated that 84.1% (95% CI: 78.8, 89.4) of respondents had a poor overall quality of life. Maternal age (>30 years) (
, 95% CI: 2.6, 12.3), marital status (divorced survivors) (
, 95% CI: 1.3, 8.5), and urinary incontinence (
, 95% CI: 2.4, 11.2) were positive predictors for poor overall quality of life. The majority of fistula survivors, 82.4%, were stigmatized which could make reintegration into the community challenging for them. Healthcare providers have to implement counseling to women for social reintegration and the possibility of gainful societal activities after repairing.
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11
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Delamou A, Douno M, Bouédouno P, Millimono S, Barry TH, Tripathi V, Diallo M. Social Immersion for Women After Repair for Obstetric Fistula: An Experience in Guinea. Front Glob Womens Health 2021; 2:713350. [PMID: 34816239 PMCID: PMC8593980 DOI: 10.3389/fgwh.2021.713350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Reintegration of women after repair of their female genital fistula remains a challenge. The objective of this study was to document the medical pathway and the reintegration process of women through the “social immersion” program of EngenderHealth in Kissidougou and Labé (Guinea). Methods: This was a qualitative descriptive study with 55 participants, including women seeking fistula care and stakeholders involved in the social immersion for repaired women in Kissidougou and Labé. The study included collecting demographic and clinical data of women, interviews with women before and after surgery, after social immersion, and 3 months post-discharge. Municipal officials, health providers, and members of host families were also interviewed. The study protocol was approved by the Guinea National Ethics Committee for Health Research. Results: The study confirmed that obstetric fistula still occurs among women living in rural and underserved areas. Most women attended at least two to five antenatal care visits, but nine over 10 reported a tragic experience of child loss associated with the occurrence of fistula. Most of them received support from their husband/partner during referral after the obstructed labor and later in the search for treatment. Women and stakeholders reported a good experience of surgery and social immersion in both Kissidougou and Labé. About 3 months after discharge, women who were continent reported being happy with their new life compared to women discharged with repair failure and residual incontinence. Conclusion: The study found the positive impacts of social immersion on the quality of life of women after fistula repair, particularly for those women who had a successful repair. The approach can be included in fistula care programs, either through direct provision or through referral to programs that can provide this service.
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Affiliation(s)
- Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Africa Centre of Excellence (CEA-PCMT), University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - Moussa Douno
- Africa Centre of Excellence (CEA-PCMT), University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - Patrice Bouédouno
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
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12
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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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El Ayadi AM, Painter CE, Delamou A, Barr-Walker J, Korn A, Obore S, Byamugisha J, Barageine JK. Rehabilitation and reintegration programming adjunct to female genital fistula surgery: A systematic scoping review. Int J Gynaecol Obstet 2020; 148 Suppl 1:42-58. [PMID: 31943181 PMCID: PMC7003948 DOI: 10.1002/ijgo.13039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Female genital fistula is associated with significant physical, psychological, and economic consequences; however, a knowledge and practice gap exists around services adjunct to fistula surgery. OBJECTIVES To examine rehabilitation and reintegration services provided adjunct to genital fistula surgery, map existing programming and outcomes, and identify areas for additional research. SEARCH STRATEGY We searched the published and grey literature from January 2000 to June 2019. Two reviewers screened articles and extracted data using standardized methods. SELECTION CRITERIA Research and programmatic articles describing service provision in addition to female genital fistula surgery were included. DATA COLLECTION AND ANALYSIS Of 3047 published articles and 2623 unpublished documents identified, 26 and 55, respectively, were analyzed. MAIN RESULTS Programming identified included combinations of health education, physical therapy, social support, psychosocial counseling, and economic empowerment, largely in sub-Saharan Africa. Improvements were noted in physical and psychosocial health. CONCLUSIONS Existing literature supports holistic fistula care through adjunct reintegration programming. Improving the evidence base requires implementing robust study designs, increasing reporting detail, and standardizing outcomes across studies. Increased financing for holistic fistula care is critical for developing and supporting programming to ensure positive outcomes.
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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
| | - Caitlyn E Painter
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.,Department of Obstetrics and Gynecology, Urogynecology Division, Kaiser Permanente, Oakland, CA, USA
| | - Alexandre Delamou
- Department of Public Health, Gamal Abdel Nasser University, Conakry, Guinea
| | - Jill Barr-Walker
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.,ZSFG Library, University of California San Francisco, San Francisco, CA, USA
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Susan Obore
- Department of Obstetrics and Gynecology, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus K Barageine
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Maternal and Child Health, Uganda Christian University, Mukono, Uganda
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14
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El Ayadi AM, Painter CE, Delamou A, Barr-Walker J, Obore S, Byamugisha J, Korn A, Barageine JK. Rehabilitation and reintegration programming adjunct to female genital fistula surgery: a scoping review protocol. BMJ Open 2019; 9:e027991. [PMID: 31619418 PMCID: PMC6797431 DOI: 10.1136/bmjopen-2018-027991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Female genital fistula is a debilitating traumatic injury, largely birth-associated, globally affecting up to 2 million women, mostly in sub-Saharan Africa. Fistula has significant physical, psychological and economic consequences. Women often face challenges in reintegrating and resuming prior roles despite successful surgery. Synthesising the evidence on services adjunct to fistula surgery and their outcomes is important for developing the evidence base for best practices and identifying research priorities. This scoping review seeks to examine the range of rehabilitation and reintegration services provided as adjunct to genital fistula surgery, map the existing programming and outcomes, and identify areas for additional research. METHODS AND ANALYSIS Our scoping review is informed by existing methodological frameworks and will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR guidelines. The search strategy will be applied to nine biomedical, public health and social science databases. The initial search was completed on 27 September 2018. Grey literature will be identified through targeted Google searches and from organisational websites identified as relevant by the United Nations Population Fund (UNFPA) Campaign to End Fistula. We will iteratively build our search strategy through term harvesting and review, and search reference lists of reports and articles to identify additional studies. Two reviewers will independently screen titles and abstracts, followed by full-text screening of all potentially relevant articles and standardised data extraction. Articles eligible for inclusion will discuss research or programmatic efforts around service provision in adjunct to surgery among females with genital fistula. Data will be presented in summary tables accompanied by narrative description. ETHICS AND DISSEMINATION Ethics approval is not required for a scoping review. Our results can be used to inform policy, serve as support for funding and development of reintegration programmes and highlight areas for subsequent research. Results will be disseminated at relevant conferences and published in a peer-reviewed journal.
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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
| | - Caitlyn E Painter
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Obstetrics and Gynecology, Urogynecology Division, Kaiser Permanente, Oakland, California, USA
| | - Alexandre Delamou
- Department of Public Health, Gamal Abdel Nasser University, Conakry, Guinea
| | - Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, San Francisco, California, USA
| | - Susan Obore
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
- Department of Maternal and Child Health, Uganda Christian University, Mukono, Uganda
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15
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Abstract
Although obstetric fistula has likely plagued women since the beginning of time, very little research proportionally exists. This article summarizes the most substantial research on the topic and delineates research gaps and future needs. Existing research demonstrates that access to care is the underlying cause of obstetric fistula and that the first attempt at closure holds the highest chance at success, ranging between 84% and 94%. For simple cases, 10 days of a catheter is sufficient, although what constitutes as simple is unclear. Circumferential fistulas are at high risk for ongoing urethral continence. Psychosocial programs are helpful for all women, but those who are "dry" tend to reintegrate into society, whereas those still leaking need additional support. Prenatal care and scheduled cesarean delivery are recommended to avoid another fistula. Gaps in research include accurate prevalence and incidence, interventions to improve access to care, surgical technique, especially for complex cases, and ways to prevent ongoing incontinence, among many others. In all areas, more rigorous research is needed.
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16
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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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17
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Keya KT, Sripad P, Nwala E, Warren CE. "Poverty is the big thing": exploring financial, transportation, and opportunity costs associated with fistula management and repair in Nigeria and Uganda. Int J Equity Health 2018; 17:70. [PMID: 29859118 PMCID: PMC5984775 DOI: 10.1186/s12939-018-0777-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 05/10/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Women living with obstetric fistula often live in poverty and in remote areas far from hospitals offering surgical repair. These women and their families face a range of costs while accessing fistula repair, some of which include: management of their condition, lost productivity and time, and transport to facilities. This study explores, through women's, communities', and providers' perspectives, the financial, transport, and opportunity cost barriers and enabling factors for seeking repair services. METHODS A qualitative approach was applied in Kano and Ebonyi in Nigeria and Hoima and Masaka in Uganda. Between June and December 2015, the study team conducted in-depth interviews (IDIs) with women affected by fistula (n = 52) - including those awaiting repair, living with fistula, and after repair, and their spouses and other family members (n = 17), along with health service providers involved in fistula repair and counseling (n = 38). Focus group discussions (FGDs) with male and female community stakeholders (n = 8) and post-repair clients (n = 6) were also conducted. RESULTS Women's experiences indicate the obstetric fistula results in a combined set of costs associated with delivery, repair, transportation, lost income, and companion expenses that are often limiting. Medical and non-medical ancillary costs such as food, medications, and water are not borne evenly among all fistula care centers or camps due to funding shortages. In Uganda, experienced transport costs indicate that women spend Ugandan Shilling (UGX) 10,000 to 90,000 (US$3.00-US$25.00) for two people for a single trip to a camp (client and her caregiver), while Nigerian women (Kano) spent Naira 250 to 2000 (US$0.80-US$6.41) for transportation. Factors that influence women's and families' ability to cover costs of fistula care access include education and vocational skills, community savings mechanisms, available resources in repair centers, client counseling, and subsidized care and transportation. CONCLUSIONS The concentration of women in poverty and the perceived and actual out of pocket costs associated with fistula repair speak to an inability to prioritize accessing fistula treatment over household expenditures. Findings recommend innovative approaches to financial assistance, transport, information of the available repair centers, rehabilitation, and reintegration in overcoming cost barriers.
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Affiliation(s)
- Kaji Tamanna Keya
- Population Council, Maternal and Newborn Health, 4301 Connecticut Avenue NW Suite 280, Washington, DC 20008 USA
| | - Pooja Sripad
- Population Council, Maternal and Newborn Health, 4301 Connecticut Avenue NW Suite 280, Washington, DC 20008 USA
| | - Emmanuel Nwala
- Population Council, No. 16 Mafemi Crescent, Off Solomon Lar Way, Utako District, Abuja, Nigeria
| | - Charlotte E. Warren
- Population Council, Maternal and Newborn Health, 4301 Connecticut Avenue NW Suite 280, Washington, DC 20008 USA
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18
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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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20
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Lavender T, Wakasiaka S, McGowan L, Moraa M, Omari J, Khisa W. Secrecy inhibits support: A grounded theory of community perspectives of women suffering from obstetric fistula, in Kenya. Midwifery 2016; 42:54-60. [PMID: 27769010 DOI: 10.1016/j.midw.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/29/2016] [Accepted: 10/02/2016] [Indexed: 11/18/2022]
Abstract
AIM this study aimed to gain understanding of the views of community members in relation to obstetric fistula. DESIGN AND METHOD a qualitative, grounded theory approach was adopted. Data were collected using in-depth interviews with 45 community members. The constant comparison method enabled generation of codes and subsequent conceptualisations, from the data. SETTING participants were from communities served by two hospitals in Kenya; Kisii and Kenyatta. Interviews took place either in the home, place of work, or hospital. FINDINGS the core category (central concept) is 'secrecy hinders support'. This was supported by three themes: 'keeping fistula hidden', 'treatment being a lottery' and 'multiple barriers to support.' These themes represent the complexities around exposure of individual fistula sufferers and the impact that lack of information and women's status can have on treatment. Keeping fistula secret reinforces uncertainties around fistula, which in itself fuels myths and ignorance regarding causes and treatments. Lack of openness, at an individual level, prevents support being sought or offered. CONCLUSIONS A multi-layered strategy is required to support women with fistula. At a societal level, the status of women in LMIC countries needs elevation to a level that provides equity in health services. At a national level, laws need to protect vulnerable women from mistreatment as a direct result of fistula. Furthermore, resources should be available to ensure provision of timely management, as part of routine services. At community level, awareness and education is required to actively engage members to support women locally. Peer support before and after fistula repair may be beneficial, but requires further research.
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Affiliation(s)
- T Lavender
- Division of Nursing, Midwifery and Social Work, The University of Manchester, United Kingdom.
| | - S Wakasiaka
- School of Nursing Sciences, University of Nairobi, Kenya
| | - L McGowan
- Faculty of Medicine and Health, The University of Leeds, United Kingdom
| | - M Moraa
- Kissi Hospital, Kissi County, Kenya
| | - J Omari
- Kissi Hospital, Kissi County, Kenya
| | - W Khisa
- Division of Nursing, Midwifery and Social Work, The University of Manchester, United Kingdom; Kenyatta National Hospital, Department of Obs/Gynae, Nairobi, Kenya
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21
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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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22
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Khisa W, Wakasiaka S, McGowan L, Campbell M, Lavender T. Understanding the lived experience of women before and after fistula repair: a qualitative study in Kenya. BJOG 2016; 124:503-510. [PMID: 26892879 DOI: 10.1111/1471-0528.13902] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To gain understanding of the first-hand experience of women prior to and following repair of a vaginal fistula, to determine the most effective support mechanisms. DESIGN Qualitative phenomenological study using a series of in-depth semi-structured interviews at two time points: prior to fistula repair and 6 months post-surgery. Data were analysed thematically. SETTING Three fistula clinics in three districts in Kenya. POPULATION A purposive sample of 16 women suffering with vaginal fistula who were seeking fistula repair. METHODS Thrity-two semi-structured interviews were conducted. RESULTS The two main themes represented the women's journeys from social isolation to social reintegration. Women felt euphoric following fistula repair, believing that a 'miracle' had occurred. However, the 'post-miracle phase' demonstrated that the social and psychological impact of fistula leaves scars that are not easily healed, even when fistula repair is successful. CONCLUSION Women's experiences of living with fistula have an impact beyond that which can be repaired solely by surgery. The findings from this study support the need for more active psychological assessment in the management of women with fistula, and the role of targeted psychological support in any package of care given in the post repair phase. The format of this support requires further study. Engagement by health professionals with the wider community could raise awareness of the causes of fistula, and provide support for significant others who may also be feeling vulnerable. It is likely that the collaborative efforts from health professionals and community members will provide the most effective support. TWEETABLE ABSTRACT Fistula surgery alone is insufficient for women's physical, social and psychological recovery.
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Affiliation(s)
- W Khisa
- Department of Obs/Gynae, Kenyatta National Hospital, Nairobi, Kenya.,School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - S Wakasiaka
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - L McGowan
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - M Campbell
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - T Lavender
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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23
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Harrison MS, Mabeya H, Goldenberg RL, McClure EM. Urogenital fistula reviewed: a marker of severe maternal morbidity and an indicator of the quality of maternal healthcare delivery. Matern Health Neonatol Perinatol 2015; 1:20. [PMID: 27057337 PMCID: PMC4823691 DOI: 10.1186/s40748-015-0020-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/14/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND While obstetric fistula has been recognized as a major maternal morbidity since the 1980s, it has become an indicator of access to and quality of women' s health care. FINDINGS Obstetric fistula still exists in low-income countries (LIC) because health care systems fail to provide adequate family planning, skilled birth attendance, basic and emergency obstetric care, and affordable treatment of fistula, while concurrently lacking social networks to serve as safety nets for affected girls and women [WHO, 2007]. CONCLUSION This review explores the most recent published experience with respect to the definition of fistula, its diagnosis, treatment, and management, and further steps for prevention of fistula on a global scale.
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Affiliation(s)
- Margo S. Harrison
- />Department of Obstetrics/Gynecology, Columbia University, New York, NY USA
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