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Zeleke LB, Welsh A, Abeje G, Khejahei M. Proportions and determinants of successful surgical repair of obstetric fistula in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2024; 19:e0303020. [PMID: 38722847 PMCID: PMC11081269 DOI: 10.1371/journal.pone.0303020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Obstetric fistula is a serious and debilitating problem resulting from tissue necrosis on the reproductive and urinary and/or lower gastrointestinal tract organs due to prolonged labor. Primary studies of the treatment of obstetric fistulae report significantly variable treatment outcomes following surgical repair. However, no systematic review and meta-analysis has yet estimated the pooled proportion and identified the determinants of successful obstetric fistula surgical repair. OBJECTIVE To estimate the proportion and identify the determinants of successful surgical repair of obstetric fistulae in low- and middle-income countries. METHODS The protocol was developed and registered at the International Prospective Register of Systematic Reviews (ID CRD42022323630). Searches of PubMed, Embase, CINAHL, Scopus databases, and gray literature sources were performed. All the accessed studies were selected with Covidence, and the quality of the studies was examined. Finally, the data were extracted using Excel and analyzed with R software. RESULTS This review included 79 studies out of 9337 following the screening process. The analysis reveals that 77.85% (95%CI: 75.14%; 80.56%) of surgical repairs in low and middle-income countries are successful. Women who attain primary education and above, are married, and have alive neonatal outcomes are more likely to have successful repair outcomes. In contrast, women with female genital mutilation, primiparity, a large fistula size, a fistula classification of II and above, urethral damage, vaginal scarring, a circumferential defect, multiple fistulae, prior repair and postoperative complications are less likely to have successful repair outcomes. CONCLUSION The proportion of successful surgical repairs of obstetric fistula in low and middle-income countries remains suboptimal. Hence, stakeholders and policymakers must design and implement policies promoting women's education. In addition, fistula care providers need to reach and manage obstetric fistula cases early before complications, like vaginal fibrosis, occur.
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Affiliation(s)
- Liknaw Bewket Zeleke
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales Sydney, Kensington, Australia
| | - Alec Welsh
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales Sydney, Kensington, Australia
| | - Gedefaw Abeje
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marjan Khejahei
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales Sydney, Kensington, Australia
- Women’s and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
- Western Sydney University, Sydney, Australia
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Chin EA, Arrowsmith S. Training and capacity building in obstetric fistula repair: A scoping review. Int J Gynaecol Obstet 2024; 164:11-18. [PMID: 37306124 DOI: 10.1002/ijgo.14901] [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: 01/17/2023] [Revised: 03/21/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND An ongoing barrier to sustainable obstetric fistula (OF) care is the lack of trained fistula surgeons. Despite a standardized training curriculum, data regarding OF repair training remain limited. OBJECTIVES To assess the availability of literature on the case numbers or training duration required for OF repair competency and whether these data are stratified by trainee background or repair complexity. SEARCH STRATEGY A systematic search of MEDLINE, Embase, and OVID Global Health electronic databases and gray literature. SELECTION CRITERIA All English sources from all years from low- and middle-income and high-income countries were eligible. Identified titles and abstracts were screened and full-text articles were reviewed. DATA COLLECTION AND ANALYSIS Data collection and analysis included a descriptive summary organized by training case numbers, training duration, trainee background, and repair complexity. RESULTS Of the 405 sources retrieved, 24 were included in the study. The only concrete recommendations were in the International Federation of Gynecology and Obstetrics 2022 Fistula Surgery Training Manual, which proposes 50 to 100 repairs (Level 1), 200 to 300 repairs (Level 2), and trainer discretion for Level 3 competency. CONCLUSIONS More case- or time-based data, particularly if stratified by trainee background and repair complexity, would be useful at the individual, institutional, and policy level for fistula care implementation or expansion.
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Affiliation(s)
- Esther Anne Chin
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Branch for Global Surgical Care, University of British Columbia, Vancouver, British Columbia, Canada
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Kumsa H, Mislu E, Arage MW, Abera A, Hailu T, Tenaw LA. Successful surgical closure and continence rate of obstetric fistula in Africa: systematic review and meta-analysis. Front Glob Womens Health 2023; 4:1188809. [PMID: 37854165 PMCID: PMC10579803 DOI: 10.3389/fgwh.2023.1188809] [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: 03/20/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023] Open
Abstract
Background A female genital fistula is an abnormal connection between a woman's reproductive tract and her urinary tract or rectum. While numerous studies have aimed to determine the success rate of obstetric fistula closure in different health settings, there remains a significant scarcity of data on closure success rates and incontinence rates for various types of fistulas at the regional and sub-regional levels. The success rate reflects the continent's healthcare setup in regard to the World Health Organization standards. Thus, this study aims to determine the success of surgical closure and the continence rate of obstetric fistula in Africa. Methods This systematic review and meta-analysis review includes studies conducted up to February 2023. Search engines like EMBBASE, Medline, Google, PubMed, Google Scholar, African Journals Online, and ScienceDirect databases were utilized to find articles. The Joanna Briggs Institute critical evaluation checklist was used to evaluate the quality of our review, which was conducted in accordance with PRISMA criteria. Heterogeneity was indicated by a p-value for I2 statistics of less than 0.05. Publication bias was assessed using the Egger regression asymmetry test. Data were entered into Microsoft Excel and analyzed using STATA 16. Result This review includes 85 studies. A total of 24 countries from East, West, Central, North, and Southern African sub-regions were included. The overall pooled estimated rate of successful obstetric fistula closure is 86.15 (95% CI: 83.88-88.42). Moreover, the pooled estimated rate of successfully closed vesico-vaginal fistulas but with ongoing or residual incontinence (wet) was revealed as 13.41% (95% CI: 11.15-15.68). The pooled estimated rate of successfully closed rectovaginal fistulas and combined VVF and RVF are 91.06% (95% CI: 86.08-96.03) and 62.21% (95% CI: 48.94-75.49), respectively. Conclusions The rate of successful obstetric fistula closure in Africa is 86.15, which is higher than the WHO target. However, the surgical closure rate of a combined VVF and RVF is 62.2%, which is significantly lower than the WHO target.
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Affiliation(s)
- Henok Kumsa
- School of Midwifery, College of Midwifery, Woldia University, Woldia, Ethiopia
| | - Esuyawkal Mislu
- School of Midwifery, College of Midwifery, Woldia University, Woldia, Ethiopia
| | | | - Atitegeb Abera
- School of Public Health, College of Midwifery, Woldia University, Woldia, Ethiopia
| | - Tilahun Hailu
- School of Public Health, College of Midwifery, Woldia University, Woldia, Ethiopia
| | - Lebeza Alemu Tenaw
- School of Public Health, College of Midwifery, Woldia University, Woldia, Ethiopia
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Ejigu N, Seyoum K, Kene C, Gomora D, Mengistu S, Geta G, Eshetu D, Tadesse S, Mesfin T, Tekalign Y, Atlaw D. Prevalence and associated risk factors for failed obstetric fistula repair in East African countries: A systematic review and meta-analysis. SAGE Open Med 2023; 11:20503121231187742. [PMID: 37492647 PMCID: PMC10363902 DOI: 10.1177/20503121231187742] [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: 02/22/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Objective Obstetric fistula repair failure is a combination of unsuccessful fistula closure and/or incontinence following a successful closure. There is an inconsistent finding on the failure of obstetric fistula repair in East Africa. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of failed obstetric fistula repair and its associated factors among women who have undergone fistula repair in East Africa. Methods This systematic review and meta-analysis were written following the PRISMA guideline protocol. A web-based electronic search of PubMed, Google Scholar, and HINARI was performed to find primary studies. Additional articles were searched by cross-referencing references. A random-effects model was used to estimate the pooled prevalence of failed obstetric fistula repair. The heterogeneity of studies was weighed using I2 test statistics. Publication bias was assessed by Eggers and funnel plot test. Results The 16 studies that met the inclusion criteria for this systematic review and meta-analysis of failed obstetric fistula repair were included. Nonetheless, one study was used for factor analysis but not in pooled prevalence analysis. The pooled prevalence of obstetric fistula repair failure in East Africa was 26.89% (95% confidence interval: 21.71, 32.07). Labor duration > 48 h (Pooled odds ratio = 2.46; 95% confidence interval 1.58, 3.82), fistula size >3 cm (Pooled odds ratio = 3.92; 95% confidence interval 2.19, 7.05), previous fistula repair (Pooled odds ratio = 3.20; 95% confidence interval 1.94, 5.29), Goh Type 4 fistulas (Pooled odds ratio = 6.07; 95% confidence interval 2.50, 14.75), completely destructed urethra (Pooled odds ratio = 3.35; 95% confidence interval 1.69, 6.65), and severe vaginal scaring (Pooled odds ratio = 3.89; 95% confidence interval 1.99, 7.62) were significantly associated with obstetric fistula repair failure. Conclusions One in four women with obstetric fistula repair experienced repair failure. To fight the problem The Ministry of Health in every part of the country, in collaboration with obstetric care providers, shall intervene on factors affecting obstetric fistula repair failure to reduce or prevent the failure of obstetric fistula repair.
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Affiliation(s)
- Neway Ejigu
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Chala Kene
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Shelema Mengistu
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Girma Geta
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Derese Eshetu
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Shimelis Tadesse
- Department of Midwifery, College of Health Sciences, Mattu University, Ethiopia
| | - Telila Mesfin
- Department of Medicine, College of Medicine and Health Sciences, Madawalabu University, Ethiopia
| | - Yohannes Tekalign
- Department of Public Health, College of Medicine and Health Sciences, Madawalabu University, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, College of Medicine and Health Sciences, Madawalabu University, Ethiopia
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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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Johnson EE, O'Connor N, Hilton P, Pearson F, Goh J, Vale L. Interventions for treating obstetric fistula: An evidence gap map. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001481. [PMID: 36963005 PMCID: PMC10021774 DOI: 10.1371/journal.pgph.0001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023]
Abstract
Obstetric fistula is prevalent in low- and middle-income countries, with between 50,000 and 100,000 new cases each year. The World Health Organization aims to eradicate it by 2030 but a clear idea of the extant evidence is unavailable. This evidence map compiled evidence on treatments for obstetric fistula to identify potential knowledge gaps. The protocol for this work was published on the Open Science Framework (DOI: 10.17605/OSF.IO/H7J35). A survey was developed, piloted and distributed online through organisations with an interest in obstetric fistula and snowballing. Results informed the evidence map framework. Searches were run on MEDLINE, Embase, CENTRAL, Global Index Medicus and ScanMedicine on 16 February 2022 to identify potentially eligible systematic reviews, randomised controlled trials, cohort studies and case-control studies. Forward and backward citation chaining was undertaken on relevant systematic reviews and included studies. Studies were screened, coded and assessed for risk of bias by a single reviewer, with a second checking a proportion. The evidence map results were compared to survey results. Thirty-nine people responded to the survey, half of which were clinicians. Of 9796 records identified, 37 reports of 28 studies were included in the evidence map. Many included studies were at some risk of bias; for observational studies, this was predominantly due to lack of controlling for confounders. Most studies (71%) assessed surgical interventions alone. Reporting on other intervention types was limited. Regarding outcome measures most important to survey respondents, 24 studies reported on cure/improvement in obstetric fistula and 20 on cure/improvement in urinary incontinence. Reporting on quality of life, faecal incontinence and sexual function was limited. There is currently little robust evidence to guide patients and practitioners on the most effective treatment option for obstetric fistula. Further research is required to address evidence gaps identified.
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Affiliation(s)
- Eugenie Evelynne Johnson
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicole O'Connor
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul Hilton
- Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona Pearson
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Innovation Observatory, The Catalyst, Newcastle upon Tyne, United Kingdom
| | - Judith Goh
- Griffith University School of Medicine, Queensland, Australia
| | - Luke Vale
- Population Health Scien ces Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Kumar N, Sureka SK, Singh UP, Kapoor R, Rustagi S, Yadav P, Srivastava A, Kapoor R. Vesicovaginal Fistula Repair by Transvaginal Route: Comparison of Resource Utilisation and Outcome with Literature Reported Population Matched Cohort of Patients Operated by Minimally Invasive Route. J Obstet Gynaecol India 2022; 72:414-419. [PMID: 36458065 PMCID: PMC9568645 DOI: 10.1007/s13224-021-01549-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/11/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction and Objectives VVF is conventionally repaired by open transvaginal or transabdominal routes. In last few decades, minimally invasive techniques (laparoscopic/robotic) for VVF repair have gained popularity. We have reported our experience of transvaginal vesicovaginal fistula (VVF) repair and compared it with the literature reported population matched cohort of VVF repair done by laparoscopic or robot-assisted techniques. Material and Methods Intraoperative and post-operative parameters including aetiology of fistula, location, operative time, blood loss, major complications, hospital stay and success rate of 202 patients with simple VVF undergoing transvaginal repair at a tertiary care hospital from 1999 to 2019 were recorded. We also compared our transvaginal repair cohort (n = 202) with the literature reported cohort of 260 patients undergoing VVF repair by minimally invasive (laparoscopic and robot assisted) techniques in the systematic review by Miklos et al. Results Most common aetiology of VVF in our series was post hysterectomy in 122 (60.39%) cases followed by trauma during emergency caesareans section in 80 (39.60%) cases. Transvaginal route had higher success rate than minimally invasive approach (99.50 vs. 96.50%, respectively). Mean operative time was lesser in transvaginal group than the minimally invasive group (63 ± 16 min vs. 161.56 ± 41.02 min, p < 0.01) with shorter mean hospital stay in transvaginal group (3 ± 1 days vs. 3.5 ± 1.16 days, respectively, p < 0.01). Mean estimated blood loss was significantly lesser in transvaginal repair (p < 0.01). 62% patients were sexually active at last follow-up. The cost of transvaginal VVF repair is significantly lower compared to repair by minimally invasive approach. Conclusion Transvaginal VVF repair is comparable to minimally invasive approach in terms of post-operative outcomes and morbidity; however, transvaginal repair performs better in terms of cost and resource utilization.
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Affiliation(s)
- Naveen Kumar
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rohit Kapoor
- Department of Urology, DY Patil Medical College, Pune, India
| | - Sanchit Rustagi
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplant, Medanta Hospital, Lucknow, India
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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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Aliyu SU, Hanif SM, Lawal IU. Effect of Paula exercise method on functional outcomes of women with post fistula repair incontinence: a protocol for randomized controlled trial. BMC WOMENS HEALTH 2021; 21:101. [PMID: 33750376 PMCID: PMC7941917 DOI: 10.1186/s12905-021-01249-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Post-fistula-repair incontinence (PFRI) is a common complication of vesicovaginal fistula (VVF) surgeries. It entails continuous leakage of urine after successful VVF closure. Pelvic Floor Muscle Training (PFMT) plays a vital role in the management of PFRI, however, an evolving exercise approach is the Paula Exercise Method (PEM) which has shown a promising effect in stopping urinary incontinence, but there is no data on its effect on PFRI. This study therefore, proposes to primarily investigate the effect of PEM on urine leakage and secondarily, pelvic floor strength (PFS), quality of life (QoL), sexual function (SF), and mental health (MH) in women with PFRI. METHODS This is a study protocol for a randomized controlled trial. A total of 182 participants are expected to participate in the study after satisfying the inclusion criteria. The participants will be randomized into either PEM or PFMT study groups. The demographic data of all the participants will be recorded. Each participant will be assessed for urine leakage, PFS, QoL, SF, and MH at baseline and subsequently, at four, eight and 12 weeks of intervention. Demographic parameters will be summarized using descriptive statistics. Continuous data will be computed for differences using inferential statistic of Analysis of variance, t-test and Man Whitney U as appropriate. All analyses will be performed using SPSS version 22.0 with probability set at 0.05 alpha level. DISCUSSION It is hoped that the outcome of this study will determine the effect of the Paula exercise method on urine leakage, pelvic floor strength, quality of life, sexual function, and mental health among women with post-fistula-repair incontinence and also provide evidence for the use of the Paula method in urinary incontinence. TRIAL REGISTRATION Pan African Clinical Trials Registry ( www.pactr.org ), identifier PACTR201906515532827.
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Affiliation(s)
- Saratu Umar Aliyu
- Department of Physiotherapy, Rasheed Shekoni Teaching Hospital, Dutse, Jigawa State, Nigeria.,Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Shmaila M Hanif
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, England
| | - Isa Usman Lawal
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria.
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Abstract
Although approximately 2 million women suffer from an obstetric fistula, the surgical literature is sparse. This review examines the evidence published to date. The most relevant surgical evidence is included, highlighting the need for further scientific investigations to contribute to our surgical practice. The most pressing needs relate to anti‐incontinence techniques and complex obstetric fistula repairs. This summary of surgical techniques and procedures in obstetric fistula repair demonstrates the need for more evidence and innovation.
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Affiliation(s)
- Rachel Pope
- Division of Global Women's Health, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Meghan Beddow
- Division of Global Women's Health, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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11
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Benski AC, Delavy M, Rochat CH, Viviano M, Catarino R, Elsig V, Doulougou A, Petignat P, Vassilakos P. Prognostic factors and long-term outcomes of obstetric fistula care using the Tanguiéta model. Int J Gynaecol Obstet 2019; 148:331-337. [PMID: 31778211 DOI: 10.1002/ijgo.13071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/18/2019] [Accepted: 11/26/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To identify factors influencing the long-term prognosis after surgical repair of obstetric fistula, establish a prognosis-based classification system, and examine changes in quality of life after surgery. METHODS A retrospective study of 308 women who underwent obstetric fistula repair at Saint Jean de Dieu Hospital, Tanguiéta, Benin, between 2008 and 2016, and were supported by a multidisciplinary management model. All participants were from rural areas of Burkina Faso. The women completed interviews before, immediately after, and 2, 4-6, and 12 months after surgery to assess their clinical state and socioeconomic and psychologic status. RESULTS Overall, the fistulae of 230/274 (83.9%) women were considered to be repaired after 12 months. Factors associated with poor repair outcome included the presence of sclerotic tissue (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.11-0.53) and intraoperative complications (OR, 0.16; 95% CI, 0.07-0.39). Women with successful surgery had a better quality of life as compared with women with an unrepaired fistula (Ditrovie score, 1.1 vs 3.9; P<0.001). CONCLUSION The multidisciplinary Tanguiéta model for management of obstetric fistula allowed successful fistula closure, thereby facilitating the women's long-term social reintegration, and improved quality of life.
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Affiliation(s)
- Anne-Caroline Benski
- Gynecology Division, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Martine Delavy
- Gynecology Division, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Charles-Henry Rochat
- Generale Beaulieu Clinic, Geneva, Switzerland.,Geneva Foundation for Medical Education and Research, Geneva, Switzerland.,Faculty of Health Sciences, Cotonou, Benin
| | - Manuela Viviano
- Gynecology Division, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Rosa Catarino
- Gynecology Division, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Patrick Petignat
- Gynecology Division, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Vassilakos
- Gynecology Division, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.,Geneva Foundation for Medical Education and Research, Geneva, Switzerland
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12
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ACOG Committee Opinion No. 759: Ethical Considerations for Performing Gynecologic Surgery in Low-Resource Settings Abroad. Obstet Gynecol 2019; 132:e221-e227. [PMID: 30629569 DOI: 10.1097/aog.0000000000002929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Global surgical care programs present obstetrician-gynecologists with important opportunities to address disparities in women's health and health care worldwide. However, these programs also present a unique set of practical and ethical challenges. Obstetrician-gynecologists are encouraged to participate in surgical care efforts abroad while taking the necessary steps to ensure that their patients can make informed decisions and receive benefit from and are not harmed by their surgical care. In this document, the Committee on Ethics highlights some of the ethical issues that may arise when providing surgical care in low-resource settings to help guide obstetrician-gynecologists in providing the best care possible. This document has been updated to broaden its focus beyond the example of obstetric fistulae, to address issues pertinent to medical trainees, and to include new information to guide physicians' return home from participation in global surgical care programs. Although clinical research has an important role in the surgical care of patients in global settings, a complete discussion of the conduct of ethical research in global settings is beyond the scope of this document.
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13
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Beardmore-Gray A, Greenwell T. Vesico-vaginal fistulae in the resource-limited setting: current status and the challenges that lie ahead, all you need to know for those practicing in a well-resourced setting. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818764593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review we examine the incidence, aetiology, pathology and classification of vesico vaginal fistulae (VVF) in the resource poor setting. We compare the diagnosis, management and outcomes of VVF repair in resource-poor countries to current practice in the well-resourced setting, finally looking ahead to the future and the changes we need to make on a global scale in order to prevent this debilitating condition. There is a clear need for more accurate data collection and classification systems appropriate to the setting. Lack of facilities such as radiology limit diagnostic capabilities and options for repair, however outcome data from resource poor countries is promising. Most importantly, a holistic approach, which examines not just the physical aspects of the condition but the social and cultural factors predisposing women to VVF, needs to be adopted when considering prevention and management of this injury. Level of evidence: Not applicable as this is a review article.
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14
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Breen M, Ingber M. Controversies in the management of vesicovaginal fistula. Best Pract Res Clin Obstet Gynaecol 2018; 54:61-72. [PMID: 30037532 DOI: 10.1016/j.bpobgyn.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/24/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
Achieving 100% closure and continence rate in the management of vesicovaginal fistulas remains a challenge. There is still debate about several aspects of the care including the following.
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Affiliation(s)
- Michael Breen
- Centre de Soins des Fistules, Centre Hospitalier Universitaire Toamasina, Hospital Be Toamasina, Boite Postale, 501 Toamasina, Madagascar.
| | - Michael Ingber
- The Center for Specialized Women's Health, Garden State Urology, Atlantic Health System, 3155 State Route 10E, Suite 100, Denville, NJ, 07834, USA.
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15
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Ruder B, Cheyney M, Emasu AA. Too Long to Wait: Obstetric Fistula and the Sociopolitical Dynamics of the Fourth Delay in Soroti, Uganda. QUALITATIVE HEALTH RESEARCH 2018; 28:721-732. [PMID: 29415634 DOI: 10.1177/1049732317754084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Uganda has one of the highest obstetric fistula rates in the world with approximately 200,000 women currently suffering. Surgical closure successfully treats fistula in the majority of cases, yet there is a severe shortage of facilities and trained surgeons in low-resource countries. The purpose of this study was to examine Ugandan women's experiences of obstetric fistula with the aim of adding narrative depth to the clinical literature on this devastating birth injury. Data were collected through semistructured interviews, focus groups, and participant observation. Resulting narratives were consensus coded, and key themes were member-checked using reciprocal ethnography. Women who suffered from fistula described barriers in accessing essential obstetric care during labor-barriers that are consistent with the three delays framework developed by Thaddeus and Maine. In this article, we extend this scholarship to discuss a fourth, critical delay experienced by fistula survivors-the delay in the diagnosis and treatment of their birth injury.
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Affiliation(s)
- Bonnie Ruder
- 1 Oregon State University, Corvallis, Oregon, USA
| | | | - Alice Aturo Emasu
- 2 The Association for Rehabilitation and Re-Orientation of Women for Development, Soroti, Uganda
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16
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Hillary CJ, Chapple CR. The choice of surgical approach in the treatment of vesico-vaginal fistulae. Asian J Urol 2018; 5:155-159. [PMID: 29988887 PMCID: PMC6033194 DOI: 10.1016/j.ajur.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 06/01/2017] [Accepted: 06/23/2017] [Indexed: 11/06/2022] Open
Abstract
Vesico-vaginal fistula is a global healthcare problem that has a high prevalence in sub-Saharan Africa, where obstetric complications lead to the development of this condition. Despite this, comparatively few fistula repairs are performed in well-resourced countries, where iatrogenic injury is the leading aetiological factor. As a consequence, much of our knowledge results from the experience of relatively few fistula surgeons in areas of high prevalence borne out of large case series or retrospective cohorts rather than high level evidence. At present, debate surrounds the exact timing of repair and the most appropriate surgical approach for this condition. Certain fistulae can be selected for conservative management, while those that do not demonstrate factors associated with spontaneous closure can be selected for surgery. Fistula surgeons should be aware of several potential repair options and the principles of contemporary fistula surgery, as the first attempt at repair is likely to be the best opportunity to achieve a successful outcome. We review the available literature and provide evidence on the optimal timing of repair, the appropriate surgical approach and the use of tissue interpositioning in fistula surgery.
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17
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Letchworth P, MacLaren E, Duffy S. Obstetric fistula: a paradigm shift is needed in research and prevention. BJOG 2017; 125:925-928. [PMID: 29281180 DOI: 10.1111/1471-0528.15110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 12/01/2022]
Affiliation(s)
- P Letchworth
- Chelsea and Westminster Hospital Foundation Trust, London, UK.,CW+ New Futures Group (charity for the Chelsea and Westminster Hospital NHS Foundation Trust), London, UK
| | - E MacLaren
- Chelsea and Westminster Hospital Foundation Trust, London, UK.,CW+ New Futures Group (charity for the Chelsea and Westminster Hospital NHS Foundation Trust), London, UK
| | - S Duffy
- Chelsea and Westminster Hospital Foundation Trust, London, UK.,CW+ New Futures Group (charity for the Chelsea and Westminster Hospital NHS Foundation Trust), London, UK
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18
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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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19
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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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20
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Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery. Obstet Gynecol 2017; 128:945-953. [PMID: 27741181 DOI: 10.1097/aog.0000000000001687] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a risk score to identify women with vesicovaginal fistula at high risk of residual urinary incontinence after surgical repair. METHODS We conducted a prospective cohort study among 401 women undergoing their first vesicovaginal fistula repair at a referral fistula repair center in Lilongwe, Malawi, between September 2011 and December 2014, who returned for follow-up within 120 days of surgery. We used logistic regression to develop a risk score to identify women with a high likelihood of residual urinary incontinence, defined as incontinence grade 2-5 within 120 days of vesicovaginal fistula repair, based on preoperative clinical and demographic characteristics (age, number of years with fistula, human immunodeficiency virus status, body mass index, previous repair surgery at an outside facility, revised Goh classification, Goh vesicovaginal fistula size, circumferential fistula, vaginal scaring, bladder size, and urethral length). The sensitivity, specificity, and positive and negative predictive values of the risk score at each cut point were assessed. RESULTS Overall, 11 (3%) women had unsuccessful fistula closure. Of those with successful fistula closure (n=372), 85 (23%) experienced residual incontinence. A risk score cut point of 20 had sensitivity of 82% (95% confidence interval [CI] 72-89%) and specificity 63% (95% CI 57-69%) to potentially identify women with residual incontinence. In our population, the positive predictive value for a risk score cut point of 20 or higher was 43% (95% CI 36-51%) and the negative predictive value was 91% (95% CI 86-94%). Forty-eight percent of our study population had a risk score 20 or greater and, therefore, would have been identified for further intervention. CONCLUSION A risk score of 20 or higher was associated with an increased likelihood of residual incontinence with satisfactory sensitivity and specificity. If validated in alternative settings, the risk score could be used to refer women with a high likelihood of postoperative incontinence to more experienced surgeons.
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21
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Kopp DM, Bengtson AM, Tang JH, Chipungu E, Moyo M, Wilkinson J. Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study. BJOG 2017; 124:966-972. [PMID: 28128507 DOI: 10.1111/1471-0528.14505] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Determine whether a 1-hour pad test at discharge can identify continence status within 120 days of obstetric vesicovaginal fistula (VVF) repair. DESIGN Prospective cohort study. SETTING Fistula Care Centre in Lilongwe, Malawi. POPULATION Women with VVF who underwent repair between January 2012 and December 2014. METHODS Data on demographics, obstetric history, physical exam findings, operative management, postoperative findings, and follow up evaluations were collected on women with VVF repair. MAIN OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and a receiver operating curve (ROC) were calculated to assess the utility of using a discharge pad test at three thresholds to identify women likely to be continent at follow up. RESULTS After VVF repair, 346 women had a 1-hour pad test performed at the time of hospital discharge and completed follow up within 120 days of repair. Of these, 79.8% (n = 276) were completely continent, whereas 20.2% (n = 70) had some degree of incontinence. The sensitivity and specificity of a negative 1-hour pad test at predicting continence is 68.1% and 82.9%, respectively. With this prevalence, a negative pad test at a 1.5-g threshold demonstrates a high predictive value (PPV = 94.0%, 95% CI 90.0-96.9) in detecting women with continence after repair. CONCLUSIONS At the 1.5-g threshold, a negative pad test at discharge identifies 94% of women who will remain continent after VVF repair. Adding the pad test to fistula care can identify women who are likely to remain continent and may not need further therapies in settings where resources are limited and follow up after repair is difficult. TWEETABLE ABSTRACT A negative pad test after repair is associated with continued continence at follow up.
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Affiliation(s)
- D M Kopp
- UNC Project-Malawi, Lilongwe, Malawi
- UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA
| | - A M Bengtson
- UNC Department of Epidemiology, Chapel Hill, NC, USA
| | - J H Tang
- UNC Project-Malawi, Lilongwe, Malawi
- UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA
| | - E Chipungu
- Fistula Care Centre, Lilongwe, Malawi
- Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi
| | - M Moyo
- Fistula Care Centre, Lilongwe, Malawi
| | - J Wilkinson
- Fistula Care Centre, Lilongwe, Malawi
- Baylor College of Medicine Department of Obstetrics & Gynecology, Houston, TX, USA
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22
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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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23
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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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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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Hillary CJ, Osman NI, Hilton P, Chapple CR. The Aetiology, Treatment, and Outcome of Urogenital Fistulae Managed in Well- and Low-resourced Countries: A Systematic Review. Eur Urol 2016; 70:478-92. [PMID: 26922407 DOI: 10.1016/j.eururo.2016.02.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/03/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Urogenital fistula is a global healthcare problem, predominantly associated with obstetric complications in low-resourced countries and iatrogenic injury in well-resourced countries. Currently, the published evidence is of relatively low quality, mainly consisting retrospective case series. OBJECTIVE We evaluated the available evidence for aetiology, intervention, and outcomes of urogenital fistulae worldwide. EVIDENCE ACQUISITION We performed a systematic review of the PubMed and Scopus databases, classifying the evidence for fistula aetiology, repair techniques, and outcomes of surgery. Comparisons were made between fistulae treated in well-resourced countries and those in low-resourced countries. EVIDENCE SYNTHESIS Over a 35-yr period, 49 articles were identified using our search criteria, which were included in the qualitative analysis. In well-resourced countries, 1710/2055 (83.2%) of fistulae occurred following surgery, whereas in low-resourced countries, 9902/10398 (95.2%) were associated with childbirth. Spontaneous closure can occur in up to 15% of cases using catheter drainage and conservative approaches are more likely to be successful for nonradiotherapy fistulae. Of patients undergoing repairs in well-resourced countries, the median overall closure rate was 94.6%, while in low-resourced countries, this was 87.0%. Closure was significantly more likely to be achieved using a transvaginal approach then a transabdominal technique (90.8% success vs 83.9%, Fisher's exact test; p=0.0176). CONCLUSIONS It is difficult to conclude whether any specific route of surgery has advantage over any other, given the selection of patients to a particular procedure is based upon individual fistula characteristics. However, surgical repair should be carried out by experienced fistula surgeons, well versed in all techniques as the primary attempt at repair is likely to be the most successful. PATIENT SUMMARY Urogenital fistulae are a common problem worldwide; however, the available evidence on fistula management is poor in quality. We searched the current literature and identified that 95% of fistulae occur following childbirth in low-resourced countries, whereas 80% of fistulae are associated with surgery in well-resourced countries, where successful repair is also more likely to be achieved. The first attempt at repair is often the most successful and therefore fistula surgery should be centralised to hospitals with the most experience.
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Affiliation(s)
| | - Nadir I Osman
- Academic Urology Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul Hilton
- Department of Urogynaecology, Newcastle University, Newcastle, UK
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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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Delamou A, Delvaux T, Utz B, Camara BS, Beavogui AH, Cole B, Levin K, Diallo M, Millimono S, Barry TH, El Ayadi AM, Zhang WH, De Brouwere V. Factors associated with loss to follow-up in women undergoing repair for obstetric fistula in Guinea. Trop Med Int Health 2015; 20:1454-1461. [PMID: 26250875 DOI: 10.1111/tmi.12584] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To analyse the trend of loss to follow-up over time and identify factors associated with women being lost to follow-up after discharge in three fistula repair hospitals in Guinea. METHODS This retrospective cohort study used data extracted from medical records of fistula repairs conducted from 1 January 2007 to 30 September 2013. A woman was considered lost to follow-up if she did not return within 4 months post-discharge. Factors associated with loss to follow-up were identified using a subsample of the data covering the period 2010-2013. RESULTS Over the study period, the proportion of loss to follow-up was 21.5% (448/2080) and varied across repair hospitals and over time with an increase from 2% in 2009 to 52% in 2013. After adjusting for other variables in a multivariate logistic regression model, women who underwent surgery at Labe hospital and at Kissidougou hospital were more likely to be lost to follow-up than women operated at Jean Paul II hospital (OR: 50.6; 95% CI: 24.9-102.8) and (OR: 11.5; 95% CI: 6.1-22.0), respectively. Women with their fistula closed at hospital discharge (OR: 3.2; 95% CI: 2.1-4.8) and women admitted for repair in years 2011-2013 showed higher loss to follow-up as compared to 2010. Finally, loss to follow-up increased by 2‰ for each additional kilometre of distance a client lived from the repair hospital (OR: 1.002; 95% CI: 1.001-1.003). CONCLUSION Reimbursement of transport was the likely reason for change over time of LTFU. Reducing geographical barriers to care for women with fistula could sustain fistula care positive outcomes.
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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, Maferinyah, Guinea.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bettina Utz
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bienvenu Salim Camara
- Centre national de formation et de recherche en santé rurale de Maferinyah, Maferinyah, Guinea
| | - Abdoul Habib Beavogui
- Centre national de formation et de recherche en santé rurale de Maferinyah, Maferinyah, Guinea
| | | | | | | | | | | | - Alison Marie El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - 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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Trelles M, Dominguez L, Stewart BT. Surgery in low-income countries during crisis: experience at Médecins Sans Frontières facilities in 20 countries between 2008 and 2014. Trop Med Int Health 2015; 20:968-71. [PMID: 25877854 DOI: 10.1111/tmi.12523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Miguel Trelles
- Surgery, Anesthesia, Gynecology and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium
| | - Lynette Dominguez
- Surgery, Anesthesia, Gynecology and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA.,Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Young-Lin N, Namugunga EN, Lussy JP, Benfield N. Healthcare providers’ perspectives on the social reintegration of patients after surgical fistula repair in the eastern Democratic Republic of Congo. Int J Gynaecol Obstet 2015; 130:161-4. [DOI: 10.1016/j.ijgo.2015.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 02/12/2015] [Accepted: 04/21/2015] [Indexed: 11/30/2022]
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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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